ESPN 51th Annual Meeting

ESPN 2018


 
A CHALLENGING CASE OF INVASIVE ASPERGILLUS INFECTION IN RENAL TRANSPLANT PATIENT AFTER INTENSIVE IMMUNOSUPRESSION DUE TO REJECTION
AYSE SEDA PINARBASI 1 ABDULHAKIM COSKUN 2 NESLIHAN GUNAY 1 MUAMMER HAKAN POYRAZOGLU 1 MELIH HANGUL 3 EMINE ALP MESE 4 ISMAIL DURSUN 1 MUSTAFA ALTAY ATALAY 5 ZUBEYDE GUNDUZ 1 RUHAN DUSUNSEL 1

1- ERCIYES UNIVERSITY MEDICAL FACULTY PEDIATRIC NEPHROLOGY
2- ERCIYES UNIVERSITY MEDICAL FACULTY PEDIATRIC RADIOLOGY
3- ERCIYES UNIVERSITY MEDICAL FACULTY PEDIATRIC PULMONOLOGY
4- ERCIYES UNIVERSITY MEDICAL FACULTY INFECTION DISEASE AND CLINICAL MICROBIOLOGY
5- ERCIYES UNIVERSITY MEDICAL FACULTY CLINICAL MICROBIOLOGY
 
Introduction:

Fungal infections after solid organ transplantation are important causes of mortality and morbidity. Invasive aspergillus infections cause organ and patient loss. We describe an invasive aspergillosis in a patient receiving intensive immunosuppressive agent followed by acute rejection due to non-adherence to the medication.

Material and methods:

The patient who had been followed up for 4 years with renal transplant applied to our hospital with acute rejection clinic because of lack of compliant to medication for 2 months. She was treated with ATG and pulse-methyl prednisolone since renal biopsy was compatible with acute T cell mediated rejection. She suffered from difficulty walking after 3 months of intensive rejection treatment. Chest-X-ray showed pneumonic infiltration and increase in ground glass density at the middle zone of right lung. Three granulomatous lesions in the cerebellum and homogeneous nodular infiltrates with low/intermediate signal intensity on T1-weighted and high on T2-weighted images in the lungs were detected by MRI. Caspofungin and voriconazole were initial therapy. Immunosuppressive treatment continued with low dose tacrolimus and steroids, but MMF was discontinued. Caspofungin treatment was replaced by the liposomal amphotericin B on the 20th day of treatment due to increased sizes of lesions in the cerebellum. Three months after treatment, the lung lesions were disappeared. Then, cranial lesions stopped growing and decrement was seen at fifth month. We switched treatment from intravenous to oral variconazole. One month later, she complained with difficulty walking and headache and cranial MRI showed new lesions in the cerebellum. The treatment started again with intravenous variconazole and liposomal amphotericin B. She is still under antifungal treatment with stable renal functions.

Results:

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Conclusions:

Invasive aspergillosis is a life threatening infection in patients with kidney transplant. They should be evaluated carefully for adherence to immunosuppressive medication and then fungal infection.