Pneumocystis jirovecii pneumonia after rituximab therapy for antibody‐mediated rejection in a renal transplant recipient

Abstract

We report the case of a 54-year-old woman who underwent living-related renal transplantation for end-stage renal disease from IgA nephropathy. She was subsequently diagnosed with antibody-mediated rejection (AMR) and received rituximab, a potent B-cell suppressive agent. After therapy with rituximab, she developed Pneumocystis jirovecii pneumonia (PJP) requiring hospitalization. We discuss the increasing literature for the use of rituximab for AMR and the need for PJP prophylaxis in this setting.

Incidence and Predictive Factors for Infectious Disease after Rituximab Therapy in Kidney‐Transplant Patients

“…In kidney-transplant patients, the atrisk period for pneumocystosis is mainly within the first 6-month post-transplant, but this infection can be easily prevented by trimethoprim-sulfamethoxazole therapy (39). Pneumocystis jirovecii pneumonia has been reported in rituximab-treated non-Hodgkin's lymphoma patients (40) but also in kidney-transplant patients following rituximab therapy for antibody-mediated rejection (41 (17). Regulation of mycobacterial infection is attributed to CD4 Th1 cells (43) but also to B-cells (44 …”

Nosocomial Pneumocystis jirovecii Pneumonia: Lessons From a Cluster in Kidney Transplant Recipients

“…Recent nosocomial PJP clusters in renal transplant recipients sharing a common healthcare facility where a single P. jirovecii genotype has been reported indicate that person-to-person transmission is the most plausible (5)(6)(7)(8)(9)(10)(11)(12), yet the exact mode of transmission in immunocompromised individuals remains uncertain. Although there is no standardized method to genotype P. jirovecii, evidence indicates that methods using multilocus sequence typing (MLST) are the most discriminatory (6,7,13).…”

Fatal Late-Onset Pneumocystis Pneumonia After Rituximab: Administration for Posttransplantation Recurrence of Focal Segmental Glomerulosclerosis—Case Report

“…In the first patient, PJP developed 3 weeks after rituximab therapy. In 2 other cases, pneumonia developed respectively after 6 and 33 months [8,11]. The patient presented here developed pneumonia 10 months after transplantation and 5 months after the first dose of rituximab was administered.…”