Follow-up of young adult monozygotic twins after simultaneous critical coronavirus disease 2019: A case report.
Mateus V de Castro, Monize V R Silva, Flávia B Soares, Vivian R Cória, Michel S Naslavsky, Marilia O Scliar, Erick C Castelli, Jamile R de Oliveira, Greyce L Sasahara, Keity S Santos, Edecio Cunha-Neto, Jorge Kalil, Mayana Zatz
Author Information
Mateus V de Castro: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Monize V R Silva: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Flávia B Soares: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Vivian R Cória: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Michel S Naslavsky: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Marilia O Scliar: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Erick C Castelli: Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil.
Jamile R de Oliveira: Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Greyce L Sasahara: Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil.
Keity S Santos: Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Edecio Cunha-Neto: Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Jorge Kalil: Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Mayana Zatz: Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
Background: The influence of the host genome on coronavirus disease 2019 (COVID-19) susceptibility and severity is supported by reports on monozygotic (MZ) twins where both were infected simultaneously with similar disease outcomes, including several who died due to the SARS-CoV-2 infection within days apart. However, successive exposures to pathogens throughout life along with other environmental factors make the immune response unique for each individual, even among MZ twins. Case presentation and methods: Here we report a case of a young adult monozygotic twin pair, who caught attention since both presented simultaneously severe COVID-19 with the need for oxygen support despite age and good health conditions. One of the twins, who spent more time hospitalized, reported symptoms of long-COVID even 7 months after infection. Immune cell profile and specific responses to SARS-CoV-2 were evaluated as well as whole exome sequencing. Conclusion: Although the MZ twin brothers shared the same genetic mutations which may be associated with their increased risk of developing severe COVID-19, their clinical progression was different, reinforcing the role of both immune response and genetics in the COVID-19 presentation and course. Besides, post-COVID syndrome was observed in one of them, corroborating an association between the duration of hospitalization and the occurrence of long-COVID symptoms.
