Lasiodiplodia theobromae pneumonia in a liver transplant recipient

We report a case of Lasiodiplodia theobromae pneumonia in a patient who died 14 days after cadaveric-liver transplantation. His condition was complicated by Enterococcus faecium peritonitis. Direct microscopy analysis of the bronchoalveolar lavage specimens showed septate hyphae. A dematiaceous mold was recovered and identified as L. theobromae by microscopic morphology and EF1α gene sequencing.     

Malaria infection in transplant recipient.

A case of P. malariae infection occurring in a kidney transplant recipient is reported. The diagnosis was delayed because of atypical clinical presentation secondary to altered immune response. Serologic tests for antimalarial antibody are not reliable and diagnosis is established by visualization of the parasites in the peripheral blood smear. We can only guess what role this infection played in rejection of the transplant and whether earlier diagnosis and treatment would have saved it.     

Disseminated coccidioidomycosis detected by percutaneous liver biopsy in a liver transplant recipient

The authors report the first case, to their knowledge, of disseminated coccidioidomycosis occurring in a liver transplant recipient. The case is also interesting in that the diagnosis of disseminated coccidioidomycosis was made fortuitously, only after finding the characteristic endosporulating spherules on a percutaneous liver biopsy. In addition, the authors reviewed the literature on post-transplant infection with particular emphasis on fungal pathogens. All studies concurred that Candida species was the most prevalent infecting fungal organism when both localized and disseminated forms of infection are included. Aspergillus was the second most common offender, and disseminated infection was associated with a very grave prognosis for the transplant recipient. Rare infections with Mucor and Cryptococcus neoformans are described in the literature.     

Chimerism and tolerance in a recipient of a deceased-donor liver transplant

Complete hematopoietic chimerism and tolerance of a liver allograft from a deceased male donor developed in a 9-year-old girl, with no evidence of graft-versus-host disease 17 months after transplantation. The tolerance was preceded by a period of severe hemolysis, reflecting partial chimerism that was refractory to standard therapies. The hemolysis resolved after the gradual withdrawal of all immunosuppressive therapy.     

Disseminated acanthamoeba infection in a renal transplant recipient: a case report

Acanthamoeba species are free-living amoebae that are the causative agents of chronic granulomatous meningoencephalitis, amoebic keratitis, pulmonary lesions, cutaneous lesions and sinusitis. Immunocompromised individuals are particularly susceptible to infections with Acanthamoeba, which can be disseminated at times. We herewith report the autopsy findings of disseminated Acanthamoeba infection in a 36-year-old female, a renal transplant recipient on immunosupressants for last four years. Central nervous system showed Acanthamoeba associated chronic granulomatous meningoencephalitis, with predominant perivascular infiltrate of amoebic cysts, trophozoites and inflammatory cells. Both lungs and pancreas also showed infiltration with Acanthamoeba.     

Fatal adenovirus 32 infection in a bone marrow transplant recipient.

A case of disseminated adenovirus type 32 infection causing severe hepatitis, gastrointestinal ulceration and also with respiratory involvement is reported in a bone marrow transplant recipient. Typical viral inclusions were seen in the postmortem histological sections and adenovirus infection was confirmed using in situ hybridisation and isolation of adenovirus type 32 from separate organs at necropsy. This is the first case in which adenovirus 32 was the cause of fatal disseminated disease in a bone marrow transplant recipient.     

Chronic cholangitis caused by Bordetella hinzii in a liver transplant recipient

Bordetella hinzii was isolated in four biliary specimens collected over 6 months from a liver transplant recipient with cholangitis. The isolates were resistant to most beta-lactam antibiotics and fluoroquinolones. Molecular typing was performed by pulsed-field gel electrophoresis. These data add cholangitis to the spectrum of disease manifestations caused by B. hinzii.     

DisseminatedNocardia farcinica infection in an AIDS patient

This report describes an AIDS patient presenting with disseminatedNocardia farcinica infection diagnosed by percutaneous kidney biopsy. The isolate was initially identified asNocardia asteroides. ThoughNocardia asteroides remains sensitive to most antimicrobial agents,Nocardia farcinica is resistant to gentamicin, tobramycin and cephalosporins and is indistinguishable fromNocardia asteroides by regular laboratory methods. In view of the rising incidence of infections withNocardia farcinica, third-generation cephalosporins should not be used in the initial management ofNocardia infections, and all isolates should be submitted for antibiotic susceptibility testing.     

Disseminated fungal infection due to Saprochaete clavata in a kidney transplant recipient

Saprochaete clavata and Saprochaete capitata are closely related fungal species (family Dipodascaceae, order Saccharomycetales) that are rarely involved in the etiology of systemic infections in humans. In recent years, these yeasts are emerging as cause of life-threatening infections in patients with severe neutropenia and haematological malignancies. Infections by these fungi have been reported mostly from Mediterranean countries. To the best of our knowledge, only 2 cases of infection due to S. capitata have been reported in solid organ transplant recipients and none due to S. clavata. Herein we report a fatal case of S. clavata disseminated infection occurring in a patient with recent kidney transplantation and severe neutropenia. Patient was receiving antifungal echinocandin prophylaxis and the yeast was isolated from the blood and multiple non contiguous sites. Saprochaete spp. should be considered in the differential diagnosis of invasive mycoses in transplant recipients, especially if they are neutropenic and living or travelling in Mediterranean countries.     

Pseudallescheriasis as an aggressive opportunistic infection in a bone marrow transplant recipient

Pseudallescheria boydii is a low-virulence fungus that is the main causative agent of posttraumatic mycetoma in a nonimmunocompromised host. Immunocompromised patients are at high risk for locally invasive or disseminated Pseudallescheria infection. However, aggressive opportunistic infections due to P boydii are reported infrequently because it morphologically resembles other fungi, especially Aspergillus species, on tissue histology; therefore, such infections are not identified and treated properly. We report a case of disseminated P boydii infection in a patient following bone marrow transplantation. The identity of the fungus was not recognized until microbiologic culture results became available. Our case illustrates the importance of recognizing this fungus as an opportunistic infection in immunocompromised patients, as well as the need for culture of biopsy material for proper identification so that appropriate therapy can be instituted.     

Histologic changes resembling acute rejection in a liver transplant patient treated with terbinafine

We present a case of histologic changes resembling acute cellular rejection in a liver transplant patient treated with terbinafine. Approximately 5 years after orthotopic liver transplantation, a 51-year-old Hispanic man developed elevated liver enzyme levels. A biopsy sample was interpreted as acute cellular rejection, and the patient was treated with increased immunosuppression. Review of medications showed that the patient had been started on terbinafine approximately 4 weeks earlier for onychomycosis, and it was discontinued. A follow-up visit 2 weeks later revealed progressive jaundice, malaise, and nausea, and evaluation of a second liver biopsy sample revealed marked centrilobular cholestasis and severe bile duct damage, consistent with terbinafine hepatotoxicity. Although these histologic changes have been described in treated patients with both normal and abnormal livers, the potential for confusion with acute rejection in patients with hepatic transplantation has not previously been reported.     

Mycobacterium triplex infection in a liver transplant patient

Mycobacterium triplex was first named in 1996 as an acid-fast bacillus with features that most resemble Mycobacterium simiae and Mycobacterium avium-intracellulare complex but which possesses a distinct mycolic acid pattern as well as a distinctive 16S rRNA hypervariable region. It has been isolated from lymph node, sputum, and cerebrospinal fluid specimens, but to date only rare clinical cases of this organism have been reported in the literature. The following is a case report of M. triplex that was isolated from the pericardial and peritoneal fluid of a 13-year-old female liver transplant patient.     

Reversibility of medically unresponsive pulmonary hypertension with nesiritide in a cardiac transplant recipient

Pulmonary hypertension unresponsive to medical therapy is considered by most centers to be a contraindication for orthotopic cardiac transplantation. This article describes a patient with unresponsive severe pulmonary hypertension who, despite a combination of maximal doses of dobutamine, milrinone, and nitroprusside infusion, responded to nesiritide (Natrecor) infusion with improvement in pulmonary hemodynamics. The patient was considered a high risk for transplantation because of significant pulmonary hypertension in spite of maximum oral therapy and continuous intravenous milrinone. Severe irreversible pulmonary hypertension persisted with a combination of dobutamine, milrinone, and nitroprusside, with pulmonary artery pressure (PA) of 88/44 mm Hg, a transpulmonary gradient (TPG) of 27, and pulmonary vascular resistance (PVR) of 5.79 Wood units. Upon addition of nesiritide, within 24 hours, there was a sustained decrease in PA to 47/30, TPG of 15, and PVR of 3.75 Wood units. The patient underwent successful left ventricular assist device placement soon after nesiritide infusion demonstrated reversibility of pulmonary hypertension. He subsequently underwent uneventful orthotopic cardiac transplantation and has done well with normal right heart pressures. This case illustrates that addition of nesiritide to standard therapy can reverse significant unresponsive pulmonary hypertension and make a patient eligible for left ventricular assist device and orthotopic cardiac transplantation.     

Ralstonia mannitolilytica infection in renal transplant recipient: first report

Ralstonia mannitolilytica is being increasingly identified as an opportunist pathogen in immunocompromised patients. We report the first case of post renal transplant infection by R. mannitolilytica, in a 14-year-old recipient. The graft and the patient were saved with prompt microbiological identification, sensitivity testing and subsequent administration of appropriate antibiotic.     

Disseminated Medicopsis romeroi infection in a kidney transplant recipient: A case report

Medicopsis romeroi is a rare, dematiaceous fungus that is difficult to identify using conventional fungal tests. Although uncommon, immunocompromised patients are particularly susceptible to this opportunistic fungus. Here, we report the case of a renal transplant recipient who presented with painful disseminated subcutaneous and soft tissue lesions. Sequencing of the Internal transcribed spacer (ITS) region of the ribosomal DNA identified the fungus as Medicopsis romeroi. Additionally, tissue samples from a non-healing wound on the left forearm grew Rhizopus spp. on Sabouraud dextrose agar, indicating a Mucormycosis superinfection. The patient's condition improved with surgical intervention and antifungal therapy with Posaconazole and Terbinafine. This case demonstrates the need for a high index of suspicion in order to facilitate early diagnosis and treatment and thus reduce the risk of dissemination.