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

doi:10.3389/fmed.2022.1008585

Follow-up of young adult monozygotic twins after simultaneous critical coronavirus disease 2019: A case report

Front Med (Lausanne). 2022 Sep 29:9:1008585. doi: 10.3389/fmed.2022.1008585. eCollection 2022.

Authors

Mateus V de Castro¹, Monize V R Silva¹, Flávia B Soares^{1

2}, Vivian R Cória¹, Michel S Naslavsky^{1

2}, Marilia O Scliar^{1

2}, Erick C Castelli³, Jamile R de Oliveira^{4

5}, Greyce L Sasahara⁵, Keity S Santos^{4

5

6}, Edecio Cunha-Neto^{4

5

6}, Jorge Kalil^{4

5

6}, Mayana Zatz^{1

2}

Affiliations

¹ Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil.
² Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil.
³ Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil.
⁴ Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁵ 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.
⁶ Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil.

Abstract

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.

Keywords: COVID-19; SARS-CoV-2; genetic variants; immunity; monozygotic twins.

Publication types

Case Reports

Grants and funding

This work was supported by the São Paulo Research Foundation (FAPESP) (grant nos. 2013/08028-1, 2014/50931-3, 2014/50890-5, and 2020/09702-1), the National Council for Scientific and Technological Development (CNPq) (grant nos. 465434/2014-2, 465355/2014-5, and 404134/2020-3), and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)—Finance Code 001 and JBS S.A (grant no. 69004). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this case report, or the decision to submit it for publication. All the cited funders supported the conduction of the experiments equally.