Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis
BackgroundThe management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare ne...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.972978/full |
| _version_ | 1797961490006802432 |
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| author | Lianhu Yu Lu Zheng Hui Hu Ping Wan Yanming Lu Libo Wang Hui Yu Yiwei Chen Jianguo Zhou Qiang Xia Wenhao Zhou Ting Zhang |
| author_facet | Lianhu Yu Lu Zheng Hui Hu Ping Wan Yanming Lu Libo Wang Hui Yu Yiwei Chen Jianguo Zhou Qiang Xia Wenhao Zhou Ting Zhang |
| author_sort | Lianhu Yu |
| collection | DOAJ |
| description | BackgroundThe management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare nephrotoxicity. We report a post-liver transplant girl who was infected with SARS-CoV-2, developing a severe mixed acidosis 3 months after the transplantation. Her acidosis was improved after withdrawing of MMF, leading the suspicion that acidosis maybe a rare side effect of MMF.Case presentationA girl was admitted to our hospital due to SARS-CoV-2 infection, 3 months before admission the patient received LT due to Niemann-Pick disease (NPD). During hospitalization, blood gas analysis showed severe mixed acidosis. To relieve mixed acidosis, the patient was given oral rehydration salt and liquid replacement therapy. Considering that immunosuppressants may cause metabolic acidosis, dose of CsA was decreased and MMF was discontinued.ResultsHowever, liquid replacement therapy and decreased CsA dose cannot improve the condition. As an attempt, MMF was discontinued, and 3 days later, the girl’s acidosis was relieved, the latest blood gas analysis was normal with the original dose of CsA and no use of MMF or other IS. In addition, we used Naranjo Scale to see if adverse drug reactions (ADRs) existed. The final score was 6 which means MMF contributes to acidosis probably.ConclusionThe girl’s mixed acidosis cannot be explained by Niemann-Pick disease and SARS-CoV-2 infection. CNIs could cause metabolic acidosis but declining the dose of CsA didn’t improve her acidosis while withdrawing MMF showed a good effect. Together with the Naranjo Scale result, we suspect that acidosis maybe a rare side effect of MMF. |
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| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-04-11T00:59:02Z |
| publishDate | 2023-01-01 |
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| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-92836cffb0fb4175adeda7cdd1b1a33f2023-01-04T20:22:24ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-01-01910.3389/fmed.2022.972978972978Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosisLianhu Yu0Lu Zheng1Hui Hu2Ping Wan3Yanming Lu4Libo Wang5Hui Yu6Yiwei Chen7Jianguo Zhou8Qiang Xia9Wenhao Zhou10Ting Zhang11Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Liver Transplantation, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Respiratory Medicine, Children’s Hospital of Fudan University, Shanghai, ChinaDepartment of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, ChinaDepartment of Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Neonatology, Children’s Hospital of Fudan University, Shanghai, ChinaDepartment of Liver Transplantation, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Neonatology, Children’s Hospital of Fudan University, Shanghai, ChinaDepartment of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaBackgroundThe management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare nephrotoxicity. We report a post-liver transplant girl who was infected with SARS-CoV-2, developing a severe mixed acidosis 3 months after the transplantation. Her acidosis was improved after withdrawing of MMF, leading the suspicion that acidosis maybe a rare side effect of MMF.Case presentationA girl was admitted to our hospital due to SARS-CoV-2 infection, 3 months before admission the patient received LT due to Niemann-Pick disease (NPD). During hospitalization, blood gas analysis showed severe mixed acidosis. To relieve mixed acidosis, the patient was given oral rehydration salt and liquid replacement therapy. Considering that immunosuppressants may cause metabolic acidosis, dose of CsA was decreased and MMF was discontinued.ResultsHowever, liquid replacement therapy and decreased CsA dose cannot improve the condition. As an attempt, MMF was discontinued, and 3 days later, the girl’s acidosis was relieved, the latest blood gas analysis was normal with the original dose of CsA and no use of MMF or other IS. In addition, we used Naranjo Scale to see if adverse drug reactions (ADRs) existed. The final score was 6 which means MMF contributes to acidosis probably.ConclusionThe girl’s mixed acidosis cannot be explained by Niemann-Pick disease and SARS-CoV-2 infection. CNIs could cause metabolic acidosis but declining the dose of CsA didn’t improve her acidosis while withdrawing MMF showed a good effect. Together with the Naranjo Scale result, we suspect that acidosis maybe a rare side effect of MMF.https://www.frontiersin.org/articles/10.3389/fmed.2022.972978/fullmycophenolate mofetilmixed acidosisCOVID-19immunosuppressantsliver transplant |
| spellingShingle | Lianhu Yu Lu Zheng Hui Hu Ping Wan Yanming Lu Libo Wang Hui Yu Yiwei Chen Jianguo Zhou Qiang Xia Wenhao Zhou Ting Zhang Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis Frontiers in Medicine mycophenolate mofetil mixed acidosis COVID-19 immunosuppressants liver transplant |
| title | Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis |
| title_full | Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis |
| title_fullStr | Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis |
| title_full_unstemmed | Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis |
| title_short | Case report: One pediatric liver-transplant recipient with SARS-CoV-2 infection suffering unexplained mixed acidosis |
| title_sort | case report one pediatric liver transplant recipient with sars cov 2 infection suffering unexplained mixed acidosis |
| topic | mycophenolate mofetil mixed acidosis COVID-19 immunosuppressants liver transplant |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.972978/full |
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