SARS-CoV-2 in pleural fluid in a kidney transplant patient

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly spread all over the globe from China. Pleural involvement is not common; around 5–10% of patients can develop pleural effusion and little is known about the involvement of pleural structures in this new infection.

A 61-year-old male kidney transplant patient with a history of multiple biopsy-confirmed acute rejections and chronic allograft rejection was admitted to our COVID-19 Unit with dry cough, exertional dyspnea, oliguria, and abdominal distension. Lung ultrasound imaging, chest X-ray, and CT scan showed left pleural effusion and atelectasis of the neighboring lung parenchyma. RT-PCR was positive for SARS-CoV-2 in the pleural fluid and cytology showed mesothelial cells with large and multiple nuclei, consistent with a cytopathic effect of the virus.

This is one of few reports describing detection of SARS-CoV-2 in the pleural fluid and to the best of our knowledge, is the first to document the simultaneous presence of a direct cytopathic effect of the virus on mesothelial cells in a kidney transplant patient with COVID-19 pneumonia. The pleura proved to be a site of viral replication where signs of a direct pathological effect of the virus on cells can be observed, as we report here. RT-PCR for SARS-CoV-2 should be part of routine examination of pleural effusion even in patients with mild respiratory symptoms or with comorbidities that seem to explain the cause of effusion.

KEYWORDS:

• COVID-19
• SARS-CoV-2
• pleural fluid
• transplant

Declaration of financial/other relationships

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Declaration of interest

The authors have no conflicts of interest to declare.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors contribution

DB performed the literature search, data collection, data analysis and interpretation and wrote the manuscript. FF, EDV, MAM, LV, MGD, GG, AG, MGC, EB, SS, SV, RG and BF performed data analysis and interpretation. All authors contributed equally to clinical management of the patient during his hospital stay. All authors are guarantors of the paper, taking responsibility for the integrity of the work as a whole.

All authors read and approved the final version of the manuscript.

Additional information

Funding

There was no funding received for this article.