Yellow fever disease in a renal transplant recipient: Case report and literature review

Abstract

Yellow fever (YF) is a viral disease, with clinical presentation among immunosuppressed patients not fully understood. YF vaccination (YFV), a live vaccine, is contraindicated in patients receiving immunosuppressive treatment due to the risk of developing the disease after vaccination. We report a case of a 50‐year‐old male recipient who presented wild‐type YF five years after a deceased donor kidney transplant. He lived in a YF endemic area and inadvertently received YFV. One day after YFV, the patient presented nausea, vomiting, fever, diarrhea, polyarthralgia, thrombocytopenia, and increased levels of liver function enzymes. The serological test was compatible with YF disease, and quantitative viral load confirmed the diagnosis of wild‐type YF. The patient received supportive care for twelve days, with hospital discharge in good clinical condition and stable renal function. One month after discharge, the patient developed de novo donor‐specific anti‐HLA antibodies (DSA) and histological evidence of endothelial lesion, with a diagnosis of acute antibody‐mediated rejection (AMR), treated with plasmapheresis and human IVIg therapy. Six months after therapy, he presented normal renal function with a reduction of DSA MFI. In the reported case, we observed a clinical wild‐type YF diagnosed even after YF vaccine administration, with good clinical outcome. De novo DSA and AMR occurred after the recovering of disease, with an adequate response to therapy and preserved allograft function. We reviewed the published literature on YF and YFV in solid organ transplantation.

Vaccination Recommendations in Solid Organ Transplant Adult Candidates and Recipients

“…Notably, the risk of live vaccines in SOT recipients is linked to vaccine-mediated disease. Indeed, the use of Yellow Fever Vaccine has been associated with acute antibodymediate renal graft rejection [16].…”

Tropical Infections in the Context of Kidney Transplantation in Latin America

“…The most endemic arboviruses in tropical and subtropical areas are dengue, chikungunya, Zika, and yellow fever (YF), all of which have already been reported in KT recipients. [55][56][57][58][59] Dengue, chikungunya, and Zika transmissions occur through a bite from Aedes aegypti or Aedes albopictus mosquito or, more rarely, through blood transfusion and grafts. Zika can also be transmitted through sexual contact and perinatally.…”

“…To date, no blood or graft transmission has been reported in this population. 58,59 Treatment is based on supportive measures. The available vaccine is live attenuated and, therefore, contraindicated in immunocompromised patients.…”

Susceptibility of solid organ transplant recipients to viral pathogens with zoonotic potential: A mini-review

“…One month after the patient was discharged, he developed subclinical antibody-mediated rejection, which was resolved by plasmapheresis. 31 A patient who had undergone a kidney transplant continued to receive immunosuppressant therapy for 25 years. Due to an outbreak in his area, a vaccination campaign began, but he was not recommended to take the vaccine due to his immunocompromised state.…”