scholarly journals Secondary Hemophagocytic Lymphohistiocytosis Complicated by a Cavitary Lung Lesion in a Kidney Transplant Recipient

2021 ◽  
pp. 195-203
Author(s):  
Katarzyna Muras-Szwedziak ◽  
Maciej Tylski ◽  
Anna Masajtis-Zagajewska ◽  
Michał Nowicki
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Laboratory Tests ◽  
Kidney Transplant Recipient ◽  
Bone Marrow Aspiration ◽  
Rare Condition ◽  
High Dose ◽  
Kidney Transplant Patient ◽  
Kidney Transplant Recipients

Hemophagocytic lymphohistiocytosis (HLH) is an uncommon life-threatening condition caused by an uncontrolled immunological response. It can develop secondary to malignancies, infections, systemic diseases, and immunosuppression. Multiple risk factors may present in kidney transplant recipients; however, the cases of HLH in this population have been described sparsely. We report a case of a 39-year-old female kidney transplant recipient who presented to the hospital nearly 3.5 years after the transplantation with general malaise, recent history of weight loss, fevers, and persistent anemia. Laboratory tests showed pancytopenia, hyperferritinemia, hypertriglyceridemia, and increased activity of lactate dehydrogenase. A bone marrow aspiration revealed hemophagocytosis, which led to the diagnosis of HLH. Therapy consisting of high-dose steroids and plasma exchanges was administered, resulting in a significant improvement of blood count parameters and the patient’s general condition. While searching for the triggering disease, a single cavitary lesion in the right lung was revealed in a chest radiograph. Computed tomography scan, bronchoscopy, and additional laboratory testing did not reveal a definitive cause of the lesion. We suspect that the lesion may be a consequence of HLH. The patient was disqualified from thoracic surgery due to multiple comorbidities. Even though HLH is a rare condition, it should be taken into consideration in a kidney transplant patient presenting with unspecific symptoms accompanied by a bicytopenia. It has an unpredictable course that often results in serious complications. Thus close follow-up of the patient and a wide array of imaging and laboratory tests remain crucial.

scholarly journals Muir–Torre syndrome: sebaceous carcinoma concurrent with colon cancer in a kidney transplant recipient; a case report

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Masahiro Tomonari ◽  
Mariko Shimada ◽  
Yasuyuki Nakada ◽  
Izumi Yamamoto ◽  
Munenari Itoh ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Case Report ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Immunosuppressive Agents ◽  
Genetic Mutation ◽  
Sebaceous Carcinoma ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Abstract Background Sebaceous carcinoma is a rare but progressive malignant skin cancer, and the incidence is approximately five times higher in post-transplant patients than in people who have not received kidney transplants. Sebaceous carcinoma is sometimes found concurrently with visceral cancers and a genetic abnormality, Muir–Torre syndrome. We report the case of a female kidney transplant recipient with sebaceous carcinoma concurrent with colon cancer 10 years after transplantation. Case presentation A 43-year-old woman was admitted due to a rapidly progressive tumor on her head. Histologically, the tumor was diagnosed as sebaceous carcinoma. We diagnosed her with Muir–Torre syndrome based on the following evidence: 1) high prevalence of microsatellite instability in gene locus assay, 2) absence of mismatch repair proteins in the sebaceous carcinoma on immunohistochemical analysis, and 3) a genetic mutation of 1226_1227delAG in the MSH2 exon 7 in the lesion detected by DNA sequencing analysis. Several reports have shown an association between immunosuppressive agents and latent Muir–Torre syndrome progression. Therefore, the progression of colon cancer in this case originated from her genetic mutation for Muir–Torre syndrome and long-term use of immunosuppressive agents. Conclusion This case report not only highlights the importance of adequate diagnosis and therapy for Muir–Torre syndrome, but also suggests the further prevention of the development of malignant tumors in kidney transplant recipients. Physicians should be mindful that sebaceous carcinoma in kidney transplant recipients is highly concurrent with Muir–Torre syndrome.

scholarly journals Sepsis-like histoplasmosis in a kidney transplant patient

2018 ◽  
Vol 40 (1) ◽  
pp. 95-97 ◽  
Author(s):  
Ana Raquel Fernandes ◽  
Laila Almeida Viana ◽  
Juliana Busato Mansur ◽  
Mariana de Moraes Françoso ◽  
Daniel Wagner de Castro Lima Santos ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Skin Biopsy ◽  
Kidney Transplant ◽  
Liposomal Amphotericin ◽  
Transplant Patient ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Patient ◽  
Fungus Infection ◽  
Immunosuppressed Patients ◽  
Severe Manifestation

Abstract Histoplasmosis is a fungus infection that mainly affects immunosuppressed patients. The authors present a case of a kidney transplant recipient who developed sepsis-like histoplasmosis, na atypical but severe manifestation of the disease. The fungus was found in blood and in a skin biopsy, and the treatment with liposomal amphotericin resulted in hepatotoxicity.

scholarly journals Belatacept associated - cytomegalovirus retinitis in a kidney transplant recipient: a case report and review of the literature

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pierre-Guillaume Deliège ◽  
Justine Bastien ◽  
Laetitia Mokri ◽  
Charlotte Guyot-Colosio ◽  
Carl Arndt ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Cytomegalovirus Retinitis ◽  
Renal Allograft Recipient ◽  
Ophthalmological Examination ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk ◽  
The Right

Abstract Background To report the first case of belatacept-associated multidrug-resistant Cytomegalovirus retinitis in a kidney transplant recipient. Case presentation A 76-year-old African male renal allograft recipient was admitted for acute visual loss of the right eye. Ophthalmological examination of the right eye showed anterior uveitis and vitritis associated with large paravascular haemorrhages and yellow necrotic borders, involving the posterior pole but not the fovea. Both Cytomegalovirus DNA in plasma and aqueous humor were positive. The patient had had several episodes of Cytomegalovirus reactivation subsequent to the introduction of belatacept. His cytomegalovirus was multi-drug resistant, and was treated with maribarir, intravitreal and systemic injections of foscarnet, and anti-Cytomegalovirus human immunoglobulin. In parallel, belatacept was stopped and switched to tacrolimus. Cytomegalovirus DNA became undetectable and there was partial improvement of visual acuity at the last ophthalmologic examination, 18 months after the initial diagnosis of Cytomegalovirus retinitis. Conclusion Cytomegalovirus retinitis is an uncommon opportunistic infection in kidney transplant recipients. Cytomegalovirus retinitis is a serious infection because of the risk of blindness and the occurrence of associated life-threatening opportunistic infections. In view of the recent literature, kidney transplant recipients treated by belatacept immunosuppression may be at increased risk for Cytomegalovirus disease, notably Cytomegalovirus retinitis. The occurrence of Cytomegalovirus retinitis may help improve the selection of patients converted to belatacept.

Clinical Management of Kidney Transplant Recipients

2019 ◽  
pp. 457-459
Author(s):  
James A. Onigkeit
Keyword(s):  
United States ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Clinical Management ◽  
Living Donor ◽  
Kidney Transplant Recipient ◽  
Deceased Donor ◽  
The United States ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Kidney transplant is common. More than 19,000 kidney transplants were performed in the United States in 2017. About two-thirds were deceased donor transplants, and about one-third were living donor transplants. The clinical management of a kidney transplant recipient begins in the operating room. Posttransplant complications can be divided into 2 categories: surgical and medical.

scholarly journals Drug Interaction between Sirolimus and Ranolazine in a Kidney Transplant Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Joanna C. Masters ◽  
Mita M. Shah ◽  
Ashley A. Feist
Keyword(s):  
Drug Interaction ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Immunosuppressive Agent ◽  
Therapeutic Window ◽  
Blood Levels ◽  
Kidney Transplant Patient ◽  
Close Monitoring ◽  
Subsequent Increase

Purpose. The case of a kidney transplant recipient who experienced a probable drug interaction between sirolimus and ranolazine is reported.Summary. The narrow therapeutic window of immunosuppressive therapy in transplant recipients requires close monitoring for potential drug-drug interactions. The patient, a 57-year-old Caucasian male kidney transplant recipient, was stable for years on sirolimus as his primary immunosuppressive agent and had a history of chronic angina, for which he was prescribed ranolazine. Upon addition and dose escalation of ranolazine, whole blood sirolimus levels more than tripled, rising to immeasurably high concentrations. After holding sirolimus on multiple occasions and reducing dosage more than 50%, blood levels returned to therapeutic range, while continuing ranolazine.Conclusion. Since ranolazine is a documented P-GP and CYP3A inhibitor, and sirolimus a known substrate for both pathways, it is proposed that ranolazine inhibition of P-GP and CYP3A4 contributed to the significant elevation in sirolimus exposure. No alternative causes for the rise in sirolimus exposure were found, and assessment with the Drug Interaction Probability Scale finds this interaction to be probable. Clinicians should be aware of the potential for this interaction to cause elevated sirolimus exposure and subsequent increase in clinical effect or toxicity, in this case overimmunosuppression.

Hemophagocytic lymphohistiocytosis in a pancreas-kidney transplant recipient: response to dexamethasone and cyclosporine

2008 ◽  
Vol 70 (07) ◽  
pp. 82-86 ◽  
Author(s):  
J.M. González-Posada ◽  
D. Hernández ◽  
A. Martin ◽  
J.M. Raya ◽  
S. Pitti ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Kidney Transplant Recipient

scholarly journals TAFRO Syndrome in a Kidney Transplant Recipient That Was Diagnosed on Autopsy: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Marie Nagai ◽  
Takahiro Uchida ◽  
Muneharu Yamada ◽  
Shuuhei Komatsu ◽  
Kohei Ota ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Underlying Disease ◽  
High Dose ◽  
Histopathological Analysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Tafro Syndrome ◽  
First Case

A 57-year-old man who received a kidney transplant 4 years previously owing to unknown underlying disease presented with thrombocytopenia and fever. Hepatosplenomegaly and lymphadenopathy were observed, and development of prominent anasarca and worsening of renal function yielded the diagnosis of TAFRO syndrome. He was treated with high-dose steroids and plasmapheresis, and a thrombopoietin receptor agonist was administered for refractory thrombocytopenia. However, his general condition worsened, and he died on day 92. Histopathological analysis of a kidney autopsy specimen showed thrombotic microangiopathy characterized by glomerular endothelial swelling, mesangiolysis, and double contours of the glomerular capillary walls. His bone marrow showed megakaryocytic hyperplasia with mild reticulin fibrosis. Interestingly, these clinical and pathological features were remarkably similar to those the patient demonstrated before the kidney transplant, suggesting the recurrence of TAFRO syndrome. TAFRO syndrome is a rare systemic disorder whose concept has recently been established, but information on its long-term outcome is scarce. To our knowledge, this is the first case of TAFRO syndrome developing in a kidney transplant recipient, which suggests that disease recurrence occurs many years after the kidney transplant.

Defining High Risk in Adult Kidney Transplantation

2009 ◽  
Vol 19 (3) ◽  
pp. 252-258
Author(s):  
Keyword(s):  
High Risk ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Kidney Transplant Recipients ◽  
Extensive Experience ◽  
Substantial Impact ◽  
Adult Kidney ◽  
Definition Of ◽  
Allograft Loss

Background Because identifiable factors contribute to allograft loss, and because no consensus has been reached on the definition of high risk, an interdisciplinary group of nurses, physicians, pharmacists, and social workers was convened in May 2008. Objective Participants sought to reach consensus about the current state of science and best practices related to the definition and management of high-risk kidney transplant recipients. Methods An expert facilitator with extensive experience in leading consensus teams guided consensus-building activities, which included discussion and small-group work. Results This consensus group conceptualized the definition of the “high-risk” kidney transplant recipient and provided information to guide the multidisciplinary team in their assessment of these patients before and after transplant. Three key areas, which were conceptualized as independent scales, had a substantial impact on outcomes: (1) transplant recipient medical factors, (2) donor and recipient immunological factors, and (3) transplant recipient psychosocial factors. Though depicted separately, alteration of a specific risk on one scale could influence some risk factors on another scale. In addition, the kidney allograft itself must be considered in the assessment of high risk. Conclusions The continuum of risk described here should be useful to transplant clinicians in their assessment of high-risk adult kidney transplant patients, may aid centers in developing a more complete definition of high risk, and may lead to risk-reduction efforts.

Ehrlichia ‐induced hemophagocytic lymphohistiocytosis in a pediatric kidney transplant recipient

2021 ◽  
Author(s):  
Nisha S. Singh ◽  
Alexa L. Pagano ◽  
Allyson J. Hays ◽  
Alexander Kats ◽  
Steven M. Dahl ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Kidney Transplant Recipient

Cytomegalovirus Retinitis Diagnosis and Treatment in a Kidney Transplant Recipient

2019 ◽  
Vol 19 ◽  
Author(s):  
Victoria Oakes ◽  
Dinesh Bahl ◽  
Suresh Antony
Keyword(s):  
Case Report ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Transplant Patient ◽  
Kidney Transplant Recipient ◽  
Diagnosis And Treatment ◽  
Kidney Transplant Patient ◽  
Intravenous Ganciclovir ◽  
Cmv Retinitis ◽  
Appropriate Treatment

: Cytomegalovirus (CMV) retinitis in a kidney transplant recipient is a rare illness with only one other reported case in the literature.. We present a case of a 70-year-old kidney transplant recipient female who presented complaining of decreased vision of her right eye. She was diagnosed with CMV retinitis and started on intravenous ganciclovir. After three weeks of therapy, the patient has had no signs of CMV retinitis.. With only one other previous case report of CMV retinitis in a kidney transplant patient, appropriate treatment and predictability of recurrence are unknown.

Sign in / Sign up

Export Citation Format

Share Document