Fatal case of invasive aspergillosis and cytomegalovirus coinfection after kidney transplantation inside the Eurotransplant Senior Program

Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: a case report and review of the literature

“… Prophylaxis against CMV not reported Induction therapy not reported Deceased donor renal transplant Ninth posttransplant year Increased blood glucose, urea, and creatinine initially, then dyspnea, fever, hypoxemia Desquamative interstitial pneumonia Ganciclovir 1.5 mg/kg/day Liposomal amphotericin B 1 mg/kg/day Oral itraconazole 5 mg/kg/day and corticosteroids HRCT: bilateral ground-glass attenuation and several cavities in both lower lobes with bilateral pleural effusions CMV pp65 antigen 65 Ag+ cells/2 × 10 6 PBL Bronchoscopic specimen… Sputum culture: Aspergillus spp. Thoracoscopic lung biopsy: acute-angle multiseptate hyphae in terminal bronchioles and many multinucleated giant cells containing degenerated fungal material in the interstitium All immunosuppressants were discontinued, except for low doses of steroids Survived He became dependent on hemodialysis 9 months after discontinuing the immunosuppressants Matevossian et al [ 21 ] 66, male Diabetes nephropathy (R− D−) Prophylaxis against CMV not reported Induction therapy not reported (short-term high-dose cortisone) Deceased donor renal transplant Six weeks after transplantation Anuria due to urinary tract infection, bilateral pleural effusion, and distal hypostatic atelectasis Invasive necrotizing aspergillosis, CMV pneumonia, acute renal failure, ARDS, multiple organ failure, persistent septic state Ganciclovir 2.5 mg/kg/day ELISA for Aspergillus spp. : negative CMV-PCR: 5,000,000 copies per mm Autopsy: lung immunohistochemistry staining for CMV shows focal positive cells Autopsy: invasive necrotizing aspergillosis lung infection Immunosuppressive therapy was discontinued Deceased Our case 54, male Nephrolithiasis (R+ D?)…”