Fatal Breakthrough COVID-19 in a Heart Transplant Recipient
A 71-year-old male presented with two days’ shortness of breath, myalgias, and chills in March 2021. His temperature was 99.0 °F and heart rate was 108 beats/minute. The patient had received two doses of the COVID-19 vaccine four weeks apart, with the second dose 16 days prior to admission. Laboratory exams were significant for lymphopenia and acute kidney injury (AKI). His brain natriuretic peptide (BNP) level was found to be elevated (an indicator of heart failure). A chest X-ray showed cardiomegaly with pulmonary vascular engorgement and an electrocardiogram showed an atrial-sensed, ventricular-paced rhythm. 5 years prior the patient received an orthotopic heart transplant. The biopsy ruled out rejection. He also had a history of obesity, hypertension, unprovoked deep vein thrombosis, and dual chamber pacemaker. The patient was started on dexamethasone and remdesevir and his tacrolimus dose was adjusted to maintain therapeutic serum levels. The patient’s AKI improved...