MO194COVID-19 INFECTION IN PATIENTS RECEIVING IMMUNPSUPPRESSIVE THERAPY: EXPERIENCE OF A NORTH AFRICAN NEPHROLOGY CENTER

Background and Aims

Since its outbreak in December 2019,novel coronavirus disease 2019 (COVID-19) has become one of physicians top concerns worldwide. Special attention is payed to immunocompromised patients with whom the virus is feared to be more aggressive . Our aim was to assess outcomes in patients receiving immunosuppressive therapy who presented with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2) infection.

Method

we monitored patients undergoing immunosuppressive regimens who presented with SARS- CoV-2 infection during a four months period from September to December 2020 in the Nephrology department of Charles Nicolle’s Teaching Hospital. The diagnosis was made through nasopharyngygeal swabs. Kidney transplant patients were not included.

Results

we identified 9 patients who presented a confirmed SARS-CoV-2 infection (details are shown in figure 1). Age varied from 32 to 67 years. Gender ratio was 0,8. Six patients had hypertension and one patient had diabetes. Seven patients suffered from chronic kidney disease stage 4 (2 patients) and stage 5 (5 patients). Active smoking was noted in 4 patients. Indications for immunosuppressive therapy were vasculitis (5patients) , lupus nephritis (1 patient) , scleroderma (1patient), cryoglubulinemia (1 patient) and multiple myeloma (1 patient). Therapies used included corticosteroids alone (2 patients) or in association with cyclophosphamide (6 patients) and in one case bortezomib.COVID-19 symptoms included fever (6 patients), fatigue (7 patients), joint pain (3 patients), dry cough (all patients)and diarrhea ( one patient). Medium duration under immunosuppressive treatment was of 42,1 days when COVID-19 diagnosis was made Among the patients, six had a mild COVID-19 presentation and displayed favorable outcomes; whereas the remaining three had severe symptoms requiring high dose oxygen and died. As for the renal outcomes, we observed no detioration of kidney function following the COVID-19 infection in any of the patients .All of the patients were treated with antibiotics, heparin and vitamins.

Conclusion

SARS- CoV-2 infection is a serious condition that can threaten prognosis especially in patients receiving immunosuppressive drugs responsible for a weaker immune response. Further work on a larger group of patients is necessary to establish whether this group is more prone to contract the COVID-19 infection and have poorer outcomes.

MO232BORTEZOMIB INDUCED PERIPHERAL AND CENTRAL NEUROPATHY : ABOUT 3 CASE REPORTS

Background and Aims

Bortezomib is a proteasome inhibitor, whose efficacy in the treatment of multiple myeloma has been proven over the last years. However, its side effects may cause concern for patients as well as physicians. We focused in this study on Bortezomib-induced neuropathy, one of the most frequent complications. We present 2 cases of peripheral sensory neuropathy and one intriguing case of central neurological manifestation, all caused by Bortezomib administration.

Case 1

A 62-year-old man, with a history of diabetes and hypertension, was diagnosed with multiple myeloma in 2019. He received 2 cycles of Bortezamib (2,5 mg), Dexamethasone , and Cyclophosphamide. Each cycle included 4 doses of Bortezomib, and the cycles were 21 days apart. At the end of the second cycle the patient developed posterior cord syndrome with balance disorder and lower extremities paresthesia. Axonal sensitivo-motor polyneuropathy was confirmed by electromyography. A pharmacology investigation was conducted, and the symptoms were attributed to Bortezomib toxicity. Evolution was favourable after change in protocol to Revlimide. No recurrence was noted.

Case 2

A 64-year-old man with no prior history was diagnosed with multiple myeloma in 2020. She received a protocol of 4 cycles, 21 days apart, of Bortezomib (2.1 mg) ,Dexamethasone and Thalidomide . Three weeks after the first cycle, the patient presented with confusion, gait disturbance and four-limb pyramidal deficiency syndrome. Electromyography showed axonal sensitivo-motor polyneuropathy .In the absence of other causes, Bortezomib toxicity was suspected and the patient underwent an emergency epurative hemodialysis session, after which symptoms completely disappeared. Bortezomib doses were then reduced. The evolution was favourable.

Case 3

A 50-year-old woman was diagnosed with multiple myeloma in 2018 with Randall's disease and quadri-pyramidal syndrome. She was put on 4 courses of Bortezomib 2.4mg Cyclophosphamide and Dexamethasone, 21 days apart. After 2 coursess, she presented a generalized tonic-clonic seizure preceded by headache, dizziness and followed by speech disturbances. Biological screening for metabolic disorders and toxins was unremarkable. Cerebral MRI showed no abnormalities. Doses of Bortezomib were reduced during the following course. We then witnessed an improvement in speech and no recurrence of seizures.

Conclusion

Bortezomib induced neuropathy is a serious and debilitating complication to which physicians must pay special attention. This side effect can be managed by dose reduction or change of molecules. Outcomes are often favourable.

MO720SARS-COV2 INFECTION IN THE POPULATION ON PERITONEAL DIALYSIS

Background and Aims

The novel coronavirus disease 2019 (COVID-19) has now spread to the entire world as a highly contagious pandemic. The disease has proved to be more serious in populations with underlying diseases like kidney diseases, diabetes, or cardiovascular diseases. People with end-stage renal disease are known for their weakened immune systems and vulnerability to different types of infections. Recent studies have shown high prevalence and poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in hemodialysis patients, but its effect on peritoneal dialysis (PD) patients is still unknown.

The aim of this study was to investigate the clinical, biological, and scannographic particularities and the prognosis of SARS-CoV-2 infection in patients on PD.

Method

We conducted a monocentric descriptive study including all the confirmed cases of SARS-CoV-2 infection in the PD unit of the Nephrology department in Charles Nicolle Hospital. The first confirmed case was in March 2019 and our study period ended in January 2021. We used Real-Time Reverse Transcriptase polymerase chain reaction (RT- PCR) to confirm SARS-CoV-2 infection after nasopharyngeal swabbing.

Results

Eight patients were included: 7 men and 1 woman. The mean age was 40.25 years-old [22-60]. All the patients were hypertensive, 2 of them were diabetics and 3 of them had cardiac pathologies: coronary heart disease in 2 patients and atrial fibrillation in the other patient. One patient had history deep vein thrombosis. All the patients were on automated PD with an average duration of PD of 40.56 months [1-84]. Two of them had history of peritonitis. Regarding the revealing symptoms of COVID-19, all the patients suffered from asthenia, a deterioration of general condition was observed in 7 patients, dry cough was also present in 7 patients, 4 patients described muscle and body aches, 3 patients reported diarrhea and vomiting, dyspnea was observed in 2 patients, only one patient reported loss of taste and smell, and fever was present in only one case.Two patients had low peripheral oxygen saturation (70% and 88%). All the patients had lymphopenia with an average of 557 [900-280]. C-reactive protein was high in 6 patients with an average of 84.7 mg/l. Chest computed tomography (CT) scan was practiced in 3 patients, it was positive in all of them with average extent of damage of 60%. Four patients were admitted in hospital and one of them in the intensive care unit (ICU) for high oxygen needs. All the patients received azithromycin, and vitamin C and D and zinc supplementation. A preventive dose of heparin was prescribed in 5 patients. No patient required intubation. No patient had thromboembolic complications. Six patients fully recovered since more than one month. Regarding the other two patients we have a follow-up of only one week since the beginning of symptoms, one of them is pauci-symptomatic and the other one is still admitted in the ICU.

Conclusion

According to our findings, patients on PD are not at increased risk for severe illness from COVID-19 or other adverse outcomes.