LAUSR

Introduction: Cytomegalovirus (CMV) is one of the most common causative agents of infections that affect renal transplant recipients Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has rapidly spread worldwide The clinical presentation of this infection can vary from an asymptomatic course to acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation and extracorporeal membrane oxygenation Little of studies reported the Coinfection with SARS-COV-2 and Cytomegalovirus Methods: We describe the first case of COVID-19 and cytomegalovirus (CMV) co-infection in kidney transplant recipient Results: A 36 years old woman, with a clinical history of severe lupus erythematosus received a renal transplant from cadaveric donor on October 02, 2019 Her immunosuppressant regime included prednisone 5mg daily,tacrolimus0 15mg/kg/day and Sirolimus 1mg daily Of note, the hydroxychloroquine was interrupted since six years ago due to toxic maculopathy On july 23, 2020, she was hospitalized for recurrent CMV disease treated by intra veinous gancilovir 10 mg/kg/day for 60 days On day 35 of hospitalization, she presented an isolated cough Physical examination was otherwise unremarkable, including breath sounds on chest auscultation Her oxygen saturation was 98% A routine blood test showed worsening lymphopenia, initially improved with the gancilovir therapy She elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH) The liver enzymes were slightly increased and her serum creatinine was still within the normal range However,cough disappeared after72 hours In the meantime, a COVID-19 was diagnosed in the nurse who taked care of our patient As part of contact tracing, a nasopharyngeal swab was performed for she and it was positive for SARS CoV-2 However, she had no complaints Her physical examination and her laboratory testing were otherwise unremarkable Conclusions: we report the first case of COVID-19 in kidney transplant patient in our country with excellent outcome despite the coinfection with SARS-COV-2 and Cytomegalovirus (CMV) So, it can be supposed that she might be protected by the antiviral therapy, ganciclovir or by the immunomodulatory effects of CMV No conflict of interest