{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:39:20Z","timestamp":1780619960704,"version":"3.54.1"},"update-to":[{"DOI":"10.12688\/f1000research.55625.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000}}],"reference-count":6,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Despite many studies on COVID-19, our knowledge of it remains incomplete. In some cases, treating SARS-CoV-2 infection concomitant with other diseases can be particularly challenging, as finding an appropriate treatment may involve some risks.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Case presentation:<\/ns4:bold>\n                    A 34-year-old SARS-CoV-2 positive patient admitted due to fever, dyspnoea, haemoptysis and pneumonia, developed alveolar haemorrhage and acute kidney injury. Due to his severe state, abnormalities in laboratory tests and rapidly progressing loss of kidney function, kidney biopsy, as well as antibody panel were carried out, in which perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) were found with a high titer (&gt;200; N: &lt;1:20). The results of kidney biopsy, combined with clinical manifestation and laboratory findings prompted the diagnosis of rapidly progressing glomerulonephritis (RPGN) in the course of p-ANCA vasculitis. Initial treatment consisted of heamodialyses, remdesivir, plasmaphereses, intravenous immunoglobulins, antibiotics, corticosteroids and nadroparin. Once the haemorrhage had subsided, kidney function had been partially retrieved and heamodialyses had no longer been necessary, cyclophosphamide treatment was initiated, despite being contraindicated in COVID-19 according to its summary of product characteristics.\u00a0Immunotherapy is still continued. The patient has already received a total of 2.4g of cyclophosphamide (4 cycles of 600mg each every three weeks). Pulmonary and radiological regression, as well as improvement of renal parameters have been achieved.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    We suspect that cyclophosphamide, the drug of choice in p-ANCA vasculitis, could be a potential factor providing regression of the radiological changes in the lungs and it could have prevented the patient from developing acute respiratory distress syndrome. COVID-19 diagnosis should not exclude searching for other diseases which can have a similar course. When treating a patient in a life-threatening condition, a departure from trying to find the perfect timing of cyclophosphamide delivery should be considered, as delaying it could cause potentially greater harm.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.55625.2","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T13:00:08Z","timestamp":1635166808000},"page":"829","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case Report: Cyclophosphamide in COVID-19 \u2013 when an absolute contraindication is an absolute necessity"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7592-656X","authenticated-orcid":false,"given":"Kamila","family":"Bo\u0142tu\u0107","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ada","family":"Bielejewska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Coloma-Millar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Dziugie\u0142","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arkadiusz","family":"Bociek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Perkowska-Ptasi\u0144ska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-1723","authenticated-orcid":false,"given":"Andrzej","family":"Jaroszy\u0144ski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2052-9","DOI":"10.1001\/jama.2020.6775","article-title":"Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area.","volume":"323","author":"S Richardson","year":"2020","journal-title":"JAMA - J Am Med Assoc."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e215-9","DOI":"10.1016\/j.chest.2020.06.051","article-title":"Two Immunocompromised Patients With Diffuse Alveolar Hemorrhage as a Complication of Severe Coronavirus Disease 2019.","volume":"158","author":"C L\u00f6ffler","year":"2020","journal-title":"Chest."},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.24875\/AIDSRev.200001261","article-title":"The Importance of Understanding the Stages of COVID-19 in Treatment and Trials.","volume":"23","author":"D Griffin","year":"2021","journal-title":"Aids Rev."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1407-11","DOI":"10.1007\/s42399-020-00438-2","article-title":"Efficacy of Plasmapheresis and Immunoglobulin Replacement Therapy (IVIG) on Patients with COVID-19.","volume":"2","author":"R Pourahmad","year":"2020","journal-title":"SNCompr Clin Med."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"AnnalsATS.202008-1002OC","DOI":"10.1513\/AnnalsATS.202008-1002OC","article-title":"Persistent Post-COVID-19 Inflammatory Interstitial Lung Disease: An Observational Study of Corticosteroid Treatment.","volume":"0","author":"K Myall","year":"2021","journal-title":"Ann Am Thorac Soc."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"109850","DOI":"10.1016\/j.mehy.2020.109850","article-title":"A potential role for cyclophosphamide in the mitigation of acute respiratory distress syndrome among patients with SARS-CoV-2.","volume":"144","author":"S Revannasiddaiah","year":"2020","journal-title":"Med Hypotheses."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-829\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-829\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-829\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T13:00:10Z","timestamp":1635166810000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-829\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,25]]},"references-count":6,"URL":"https:\/\/doi.org\/10.12688\/f1000research.55625.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.78504.r97919","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,25]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-829\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.59218.r92236, Anna Clementi, Nephrology and Dialysis Department, Santa Marta and Santa Venera Hospital, Acireale, Catania, Italy, 03 Sep 2021, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/10-829\/v1#referee-response-92236","order":0,"name":"referee-response-92236","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kamila Bo\u0142tu\u0107<\/b>; \n<i>Posted: 02 Oct 2021<\/i>; Thank you so much for this detailed review.&nbsp; We tried to highlight the possibility of the COVID-19 concomitance with various diseases. Moreover, based on this case we wanted to demonstrate the complexity of treatment in COVID-19 patients.&nbsp; We are glad that our case report met your expectations and due to sufficient detail may be useful for other clinicians.","URL":"https:\/\/f1000research.com\/articles\/10-829\/v2#referee-comment-7269","order":1,"name":"referee-comment-7269","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.59218.r93992, Krzysztof J. Filipiak, 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland, 10 Sep 2021, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/10-829\/v1#referee-response-93992","order":2,"name":"referee-response-93992","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kamila Bo\u0142tu\u0107<\/b>; \n<i>Posted: 03 Oct 2021<\/i>; Thank you so much for your review. In this particular case, we wanted to highlight the complexity of treatment in COVID-19 patients and present the difficulties associated with it. We are glad that this case report met your expectations and may be useful for other clinical practitioners. Additionally, thank you for finding an error with the drug. It should be Nadroparin and it will be changed.","URL":"https:\/\/f1000research.com\/articles\/10-829\/v2#referee-comment-7270","order":3,"name":"referee-comment-7270","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}