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A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient

BACKGROUND: Renal transplant recipients are at high risk of developing multiple infections, often concomitantly because of their immunocompromised status. Post renal transplant infections are often elusive and require extensive evaluation for proper diagnosis and treatment. A high index of suspicion...

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Autores principales: Rathi, Manish, Gundlapalli, Srikant, Ramachandran, Raja, Mohindra, Sandeep, Kaur, Harsimran, Kumar, Vivek, Kohli, Harbir Singh, Gupta, Krishan Lal, Sakhuja, Vinay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032160/
https://www.ncbi.nlm.nih.gov/pubmed/24885965
http://dx.doi.org/10.1186/1471-2334-14-259
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author Rathi, Manish
Gundlapalli, Srikant
Ramachandran, Raja
Mohindra, Sandeep
Kaur, Harsimran
Kumar, Vivek
Kohli, Harbir Singh
Gupta, Krishan Lal
Sakhuja, Vinay
author_facet Rathi, Manish
Gundlapalli, Srikant
Ramachandran, Raja
Mohindra, Sandeep
Kaur, Harsimran
Kumar, Vivek
Kohli, Harbir Singh
Gupta, Krishan Lal
Sakhuja, Vinay
author_sort Rathi, Manish
collection PubMed
description BACKGROUND: Renal transplant recipients are at high risk of developing multiple infections, often concomitantly because of their immunocompromised status. Post renal transplant infections are often elusive and require extensive evaluation for proper diagnosis and treatment. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. CASE PRESENTATION: We report a 50-year-old female, a renal allograft recipient who presented with left hemiplegia, esophageal ulcers and fever 3 months after her transplant. Esophageal biopsy revealed Cytomegalovirus (CMV) inclusions and the whole blood quantitative CMV polymerase chain reaction (PCR) was positive. Neuroimaging showed a brain abscess, stereotactic biopsy from which revealed Scedosporium apiospermum on fungal culture. Her tacrolimus and mycophenolate were stopped and she was managed with intravenous ganciclovir and voriconazole. With these measures, she showed marked improvement in her general and neurological condition. Two months later, she developed recurrence of fever with dry cough. Radiological investigation revealed a cavitating lung lesion, a needle aspiration from which demonstrated acid-fast bacilli. She was started on antituberculous treatment. With these measures, she recovered completely and maintained good graft function despite being on only prednisolone 10 mg once a day. CONCLUSION: Although CMV disease is not uncommon in the first three months post transplant, Scedosporium is a rare cause of brain abscess. On the other hand, tuberculosis is common in transplant recipients, especially in developing countries, like India. However, this is the first case report of occurrence of these three infections in the same patient, demonstrating the importance of a good microbiological work-up from each site involved in immunosuppressed subjects.
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spelling pubmed-40321602014-05-24 A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient Rathi, Manish Gundlapalli, Srikant Ramachandran, Raja Mohindra, Sandeep Kaur, Harsimran Kumar, Vivek Kohli, Harbir Singh Gupta, Krishan Lal Sakhuja, Vinay BMC Infect Dis Case Report BACKGROUND: Renal transplant recipients are at high risk of developing multiple infections, often concomitantly because of their immunocompromised status. Post renal transplant infections are often elusive and require extensive evaluation for proper diagnosis and treatment. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. CASE PRESENTATION: We report a 50-year-old female, a renal allograft recipient who presented with left hemiplegia, esophageal ulcers and fever 3 months after her transplant. Esophageal biopsy revealed Cytomegalovirus (CMV) inclusions and the whole blood quantitative CMV polymerase chain reaction (PCR) was positive. Neuroimaging showed a brain abscess, stereotactic biopsy from which revealed Scedosporium apiospermum on fungal culture. Her tacrolimus and mycophenolate were stopped and she was managed with intravenous ganciclovir and voriconazole. With these measures, she showed marked improvement in her general and neurological condition. Two months later, she developed recurrence of fever with dry cough. Radiological investigation revealed a cavitating lung lesion, a needle aspiration from which demonstrated acid-fast bacilli. She was started on antituberculous treatment. With these measures, she recovered completely and maintained good graft function despite being on only prednisolone 10 mg once a day. CONCLUSION: Although CMV disease is not uncommon in the first three months post transplant, Scedosporium is a rare cause of brain abscess. On the other hand, tuberculosis is common in transplant recipients, especially in developing countries, like India. However, this is the first case report of occurrence of these three infections in the same patient, demonstrating the importance of a good microbiological work-up from each site involved in immunosuppressed subjects. BioMed Central 2014-05-14 /pmc/articles/PMC4032160/ /pubmed/24885965 http://dx.doi.org/10.1186/1471-2334-14-259 Text en Copyright © 2014 Rathi et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Rathi, Manish
Gundlapalli, Srikant
Ramachandran, Raja
Mohindra, Sandeep
Kaur, Harsimran
Kumar, Vivek
Kohli, Harbir Singh
Gupta, Krishan Lal
Sakhuja, Vinay
A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
title A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
title_full A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
title_fullStr A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
title_full_unstemmed A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
title_short A rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
title_sort rare case of cytomegalovirus, scedosporium apiospermum and mycobacterium tuberculosis in a renal transplant recipient
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032160/
https://www.ncbi.nlm.nih.gov/pubmed/24885965
http://dx.doi.org/10.1186/1471-2334-14-259
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