Pneumocystis Jirovecii Pneumonia in a Kidney Transplant Recipient 13 Months after Transplantation: A Case Report and Literature Review
Open Access
- 18 January 2021
- journal article
- Published by Vilnius University Press in Acta medica Lituanica
- Vol. 28 (1), 136-144
- https://doi.org/10.15388/amed.2020.28.1.5
Abstract
Background. Pneumocystis jirovecii pneumonia (PCP) is an opportunistic and prevalent fungal infection in immunocompromised hosts, including patients after kidney transplantation (KTx). It is a life threatening infection. While with effective prophylaxis it became less common, it still remains an issue among solid organ transplant (SOT) recipients during the first year. There are no specific clinical signs for PCP. Computed tomography (CT) is a better method for detecting PCP, but definite diagnosis can only be made by identification of the microorganism either by a microscopy or by a polymerase chain reaction (PCR).Clinical case. We present a case of a 17 year old with severe PCP 13 months after KTx followed by reduction in kidney function and respiratory compromise. The pathogen was detected by PCR from bronchoalveolar lavage fluid (BALF) and patient was treated successfully with trimethoprim-sulfamethoxazole (TMP-SMX). Patient’s condition, respiratory status and kidney function gradually improved. Our presented case is unusual because patient had no known risk factors for PCP and he was more than one year after KTx, what is considered rare. In addition patient and his parents delayed in notifying the treating physician about ongoing symptoms because did not deem them important enough.Conclusions. Clinicians treating patients in risk groups for PCP must always remain vigilant even in era of effective prophylaxis. The vigilance should also extend to the patient and patient’s family.Keywords
This publication has 40 references indexed in Scilit:
- Pneumocystis Pneumonia in Solid Organ TransplantationAmerican Journal of Transplantation, 2013
- Colonization by Pneumocystis jirovecii and Its Role in DiseaseClinical Microbiology Reviews, 2012
- Pneumocystis PneumoniaSeminars in Respiratory and Critical Care Medicine, 2011
- Incidence of and risk factors for community acquired pneumonia in US HIV-infected children, 2000–2005AIDS, 2011
- Interleukin 2 receptor antagonists for kidney transplant recipientsEmergencias, 2010
- Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant RecipientsAmerican Journal of Transplantation, 2009
- Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infectionCritical Care, 2008
- Epidemiology and Clinical Significance ofPneumocystisColonizationThe Journal of Infectious Diseases, 2008
- Management of Pneumocystis jiroveci Pneumonia in Children Receiving ChemotherapyPediatric Drugs, 2007
- Rejection Treatment and Cytomegalovirus Infection as Risk Factors for Pneumocystis carinii Pneumonia in Renal Transplant RecipientsClinical Infectious Diseases, 1996