Received: January 02, 2023; Published: January 25, 2023

Abstract

We report the case of a recovered COVID-19 immunocompromised patient with severe autoimmune disease who is on several immune suppressive drugs.

His medical condition has no specific diagnosis. On 2011 he underwent total left adrenalectomy due to pheochromocytoma with trial of auto-transplant of adrenocortical tissue in the iliacus muscle. The auto-transplant failed after two years of follow-up and revealed the necessity of full hormone replacement therapy due to adrenal insufficiency. Genetic tests including whole EXOM sequencing did not revealed any known mutation related to pheochromocytoma. On 2019 he was diagnosed with Ankylosing spondylitis and optic neuritis. He was treated with high dose steroids with partial response. Therefore, Secukinumab, an interleukin 17A inhibitor, was started, with a very good clinical response initially. However, after the 6^th dose, the patient developed severe urticarial vasculitis, that completely responded to Cyclosporine. Different interleukin 17A inhibitor, Ixekizumab, was initiated. However, after two injections, the patient developed urticarial rash again. Trying to cease cyclosporine use, the patient got Omalizumab with no rash recurrence. Avoiding use of TNF inhibitors for treating ankylosing spondylitis, patient started to take Upadacitinib. Six weeks after starting the treatment he was diagnosed with COVID-19 infection.

On August 2021 the patient was diagnosed with COVID-19 infection, 8 months after he received two SARS-CoV-2 mRNA vaccine with poor serologic response (COVID-19 IgG were 25 and 169 AU/ml at 4 and 6 weeks from the second vaccine injection.).

He was presented with fever of 39.0, chills, cough, mild speech dyspnea, headache, myalgia, rhinorrhea, anosmia and ageusia. During his disease he was treated with oral Prednisone 8mg, oral Fludrocortisone 0.1mg, oral Upadacitinib 150 mg and S.C Omalizumab once monthly. Treatment course of cyclosporine 300 mg was completed one week before his presentation. Due to worsening of fatigue, tachycardia (125 bpm) and borderline hypotension (blood pressure= 95/60 mmHg), he was admitted to the hospital. His vital signs at emergency room (ER) were: pulse=120 bpm; BP= 100/60 mmHg; oxygen saturation = 95% on room air; and fever= 38.5 C. ECG showed sinus tachycardia with no signs of ischemia, and chest x-ray was normal with no signs of infiltrates. On laboratory workout, he had lymphopenia (0.82 K/µl), elevated CRP 6.5 mg/dL, LDH 253 U/L and hypophosphatemia 1.2 mg/dL. Blood glucose levels, sodium, potassium and kidney function were within normal limit. 100 mg Hydrocortisone in 1 litter normal saline was administered intravenously at the ER.

His vital signs were within the normal range, and after 2 days of admission, he was discharged. COVID-19 IgG level was 30158 AU/ml on discharge.

His symptoms improved gradually, and after 10 days of admission, he back to his work as a physician in our hospital.

Keywords: COVID-19; DMARDs; Immunocompromised

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Citation: Yaniv Yechiel and Siham Abdelgani. “COVID-19 in Vaccinated Immunocompromised Young Man". Acta Scientific Clinical Case Reports 4.2 (2023): 36-37.

Copyright: © 2022 Yaniv Yechiel and Siham Abdelgani. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.