POS-732 A STUDY OF ANGIOTENSIN ii TYPE II RECEPTOR ANTIBODY IN RENAL ALLOGRAFT REJECTION

Abstract

Cutaneous leishmaniasis is a parasitic infection caused by a flagellate parasite of the genus Leishmania. It is most often a zoonotic disease transmitted by the bite of sandflies. Methods: We report the case of a renal transplant recipient who presented with cutaneous leishmaniasis. Results: A 32-year-old man from Gafsa was received a kidney transplant in September 2017 from a living related donor (5 HLA identities). The induction immunosuppression is based on solumedrol and antilymphocyte serum. The maintenance immunosuppression is based on mycophenolate mofetil, tacrolimus and prednisone. He presented in January 2019 with two nodular lesions of two ankles (opposite the joint), the lesions were painless non-itchy ulcerative, one centimeter in diameter each. The skin smear showed a bodies of leishmanias. Initially he was received metronidazol 1500 mg per day for a month with local care, local cryotherapy and we reduce the doses of immunosuppressive drugs.After 17 days of antibiotic therapy, he developed bicytopenia (thrombocytopenia + leukopenia). Mycophenolate mofetil was discontinued and we increased the dose of corticosteroids. A myelogram done to rule out visceral leishmaniasis or infectious macrophagic activation syndrome, showed a marrow of moderate richness with an excess of promyelocytes and myelocytes. The diagnosis was metronidazol toxicity, which ended with an improvement in the blood count and a gradual reintroduction of mycophenolate mofetil.The patient was received only a local cryotherapy for 6 months resulted in improvement of the lesions. Conclusions: Infection or reactivation of leishmaniasis after immunosuppression has been rarely reported.