Alveolar echinococcosis in patient after cadaveric kidney transplantation |
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Authors: | S Dražilová J Kinčeková Ľ Beňa M Zachar M Švajdler P Zavacký P Jarčuška |
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Institution: | (1) Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstr, 266a, CH-8057 Zurich, Switzerland;(2) Division of Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland;(3) Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; |
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Abstract: | 52-years old man years following the kidney transplantation from deceased donor was admitted to the hospital with fever and
progressive abdominal pain. The patient was diagnosed with chronic hepatitis C seven years before admission. Graft function
in posttransplant period was stable and optimal, the patient was treated with standard maintenance immunosupresive protocol
(cyclosporine A, mycophenolate mofetil and low-dose prednison), metylprednisolon bolus therapy (1 g/m2 body surface area), was administered two months prior to admission due to creeping creatinine (suspection of acute rejection
was not confirmed by biopsy). Empiric antibiotic treatment due to febrile status was ineffective. Abdominal ultrasound and
computer tomography (CT) scan revealed three tumorous lesions in the liver, radical surgical intervention was not executable.
Histological examination of the tissue from the lesions demostrated alveolar echinococcosis, serology for Echinoccocus multilocularis was positive. Long-term treatment by mebendazol 200 mg twice daily led to disappearance of the clinical symptoms, but after
the therapy cessasion patient was again hospitalized with fever and progression of cystic lesions in CT scan. Following the
mebendazol therapy reinstalation the clinical course of echinococcosis was improved and remained stable, transplant kidney
failure occurred due to progression of interstitial fibrosis/tubular atrophy and chronic haemodialysis was initiated one year
later. |
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