Leprosy in a renal transplant recipient: review of the literature

Swarnalatha, G; Ram, R; Ismal, Kiranmai; Sahay, Manisha; Dakshinamurthy, KV; Girish, N; Prasad, Neela

doi:10.1111/j.1399-3062.2009.00428.x

Cited by 13 publications

(11 citation statements)

References 28 publications

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“…In addition, IRS-like syndromes have been described in post-transplant recipients during antimicrobial treatment of specific infectious conditions [19]. The few cases of transplant recipients with leprosy reactions reported in the literature represented challenging diagnosis and management [2, 10, 14, 20]. The development of a reaction was in general linked to tapering of immunosuppression, although this was not true for every case [10, 21] and the present case report.…”

Section: Discussionmentioning

confidence: 66%

“…Since these manifestations are determined at least partly by the immune response of the patient, one would expect atypical leprosy presentations in transplant recipients; however, most cases reported to date in SOT recipients presented “regular” manifestations of the infection [2, 10]. Conversely, the patient described here developed skin lesions resembling vasculitis that did not raise the suspicion of leprosy.…”

Section: Discussionmentioning

confidence: 78%

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Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells?

Vieira

Trindade²,

Paula

et al. 2017

BMC Infect Dis

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BackgroundDue to its chronic subclinical course and large spectrum of manifestations, leprosy often represents a diagnostic challenge. Even with proper anti-mycobacteria treatment, leprosy follow up remains challenging: almost half of leprosy patients may develop reaction episodes. Leprosy is an infrequent complication of solid organ transplant recipients. This case report illustrates the challenges in diagnosing and managing leprosy and its reactional states in a transplant recipient.Case presentationA 53-year-old man presented 34 months after a successful renal transplantation a borderline-tuberculoid leprosy with signs of mild type 1 upgrading reaction (T1R). Cutaneous manifestations were atypical, and diagnosis was only made when granulomatous neuritis was found in a cutaneous biopsy. He was successfully treated with the WHO recommended multidrug therapy (MDT: rifampicin, dapsone and clofazimine). However he developed a severe T1R immediately after completion of the MDT but no signs of allograft rejection. T1R results from flare-ups of the host T-helper-1 cell-mediated immune response against Mycobacterium leprae antigens in patients with immunologically unstable, borderline forms of leprosy and has been considered an inflammatory syndrome in many aspects similar to the immune reconstitution inflammatory syndromes (IRS). The T1R was successfully treated by increasing the prednisone dose without modifying the other immunosuppressive drugs used for preventing allograft rejection. Immunological study revealed that the patient had a profound depletion of both in situ and circulating regulatory T-cells and lack of expansion of the Tregs upon M. leprae stimulation compared to T1R leprosy patients without iatrogenic immunosuppression.ConclusionsOur case report highlights that leprosy, especially in the transplant setting, requires a high degree of clinical suspicion and the contribution of histopathology. It also suggests that the development of upgrading inflammatory syndromes such as T1R can occur despite the sustained immunosuppressors regimen for preventing graft rejection. Our hypothesis is that the well-known deleterious effects of these immunosuppressors on pathogen-induced regulatory T-cells contributed to the immunedysregulation and development T1R.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2406-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 78%

Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells?

Vieira

Trindade²,

Paula

et al. 2017

BMC Infect Dis

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“…It is claimed that immunosuppression does not interfere with the development or aggravation of the manifestations of leprosy. Few cases of leprosy have been reported in SOT recipients, but all of them presented as multi-bacillary leprosy (15). We reported a patient who had a history of recurrent bullous skin lesions before transplantation.…”

mentioning

confidence: 89%

Mycobacterial Disease in Renal Allograft Recipients

Ardalan¹

2013

Mycobact Diseases

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Solid organ transplant recipients have impaired cell-mediated immunity, and are at increased risk of mycobacterial infection. Mycobacterium tuberculosis infection (TB) has a high mortality rate among this population. The diagnosis of tuberculosis in solid organ transplant recipients is a big challenge and needs rapid and accurate modalities. These patients have 3.8 time greater risk of developing extra-pulmonary TB than general population. High index of suspicion and applying with invasive diagnostic procedure are needed for diagnosis of TB in renal transplanted patients.Please cite this paper as: Ardalan MR. Mycobacterial disease in renal allograft recipients. J Renal Inj Prev 2013; 2(2): 83-84.

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“…Immunosuppression in SOTRs is thought to contribute to disease severity as it reduces T-cell function [53]. All reported cases of lepromatous leprosy in SOTRs occurred in endemic areas or in patients originally from endemic regions [51][52][53][55][56][57]. Currently, there are limited data on the effect of leprosy infection on allograft function or on the association between immunosuppression and leprosy infection.…”

Section: Cutaneous Mycobacterial Infectionsmentioning

confidence: 99%

Skin Infections due to Bacteria in Solid Organ Transplant Recipients: A Review

Ilyas¹,

Maganty²,

Ginsberg³

et al. 2017

Dermatology

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Though there is an abundance of information on cutaneous malignancies in transplant recipients, cutaneous infections in solid organ transplant recipients (SOTRs) are underrepresented in the dermatological literature. Our paper provides a comprehensive review of bacterial cutaneous infections within the solid organ transplant population. Cutaneous bacterial infections may lead to significant morbidity and even mortality in this immunosuppressed population. Thus, it is to the benefit of both dermatologists and other transplant care providers to better understand and recognize the features of cutaneous bacterial infections in SOTRs. This paper can aid providers in promptly identifying, diagnosing, and treating bacterial skin infections. This review discusses the diagnosis and treatment of the following bacterial species: Staphylococcus, Streptococcus, Pseudomonas aeruginosa, Escherichia coli, Nocardia, Mycobacteria, and Bartonella henselae.

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Leprosy in a renal transplant recipient: review of the literature

Cited by 13 publications

References 28 publications

Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells?

Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells?

Mycobacterial Disease in Renal Allograft Recipients

Skin Infections due to Bacteria in Solid Organ Transplant Recipients: A Review

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