Evidence of Continued CD4+ and CD8+ T Cell Activity After SARS-COV-2 Clearance in a Late COVID-19 Pneumonia Heart Transplant Patient

We have studied an unvaccinated heart transplant 64-year-old patient admitted for low-grade fever, dry cough, general malaise, and bilateral interstitial infiltrates, after two months of a diagnosis of coronavirus disease 2019 (COVID-19) bilateral pneumonia. A bronchoalveolar lavage and transbronchi...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2022-05, Vol.14 (5), p.e24852
Main Authors: Klein, Francisco R, Renedo, María F, Vigliano, Carlos A
Format: Article
Language:English
Subjects:
Autopsies
Biopsy
Case reports
Coronaviruses
COVID-19
Cytokines
Cytotoxicity
Heart transplants
Hyperplasia
Immunocompetence
Infectious Disease
Lavage
Lymphocytes
Mortality
Pathology
Patients
Pneumonia
Severe acute respiratory syndrome coronavirus 2
Transplantation
Viral infections
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Summary:We have studied an unvaccinated heart transplant 64-year-old patient admitted for low-grade fever, dry cough, general malaise, and bilateral interstitial infiltrates, after two months of a diagnosis of coronavirus disease 2019 (COVID-19) bilateral pneumonia. A bronchoalveolar lavage and transbronchial biopsy were performed. Bacterial, mycotic and viral infections were ruled out including repeated reverse transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diffuse thickening of alveolar septa with fibrosis and infiltration of lymphocytes and macrophages into the alveolar septa with aggregates of CD4 and CD8 T cells with positive immunolabelling for granzyme B were observed, indicating a continuing cytotoxic process that might have induced proliferation and fibrosis. An intense ongoing immunopathological cellular reaction, potentially triggered by SARS-CoV-2 overcoming the anti-inflammatory and immunomodulatory effects of the immunosuppressive drugs is suggested by these findings, opening to debate the usual approach of minimizing immunosuppression after COVID-19 in transplant patients when presence of SARS-CoV-2 has been ruled out.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.24852