Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation:A case report  

作　　者：Ratna Acharya Rachel Bush Felicia Johns Kiran Upadhyay 

机构地区：[1]Department of Pediatrics,University of Florida,Gainesville,FL 32610,United States [2]Department of Pediatric Nephrology,University of Florida,Gainesville,FL 32610,United States

出　　处：《World Journal of Transplantation》2023年第4期201-207,共7页世界移植杂志

摘　　要：BACKGROUND Warts are common in recipients of kidney transplantation(KT).Resistant warts which are not amenable to conventional therapies may lead to significant morbidity.Limited data exists on safety and efficacy of local immunotherapy among immunocompromised KT recipients.CASE SUMMARY We report a seven-year-old child who presented with recalcitrant plantar periungual warts in the early KT period.Immunosuppression consisted of tacrolimus,mycophenolate and steroid.Due to failure of conventional anti-wart therapies,he was treated with two sessions of intralesional(IL)candida immunotherapy along with liquid nitrogen cryotherapy leading to complete resolution of the warts.Interestingly,de novo BK viremia was seen about three weeks following the last candida immunotherapy.This required reduction of immunosuppression and other anti-BK viral therapies.Allograft function remained stable but there were donor specific antibodies detected.There also was elevated level of plasma donor derived cell-free DNA.A pneumocystis jirovecii pneumonia occurred ten months following completion of immunotherapy that was successfully treated with trimethoprim-sulfamethoxazole.During this ten-month follow-up period,there have been no recurrence of warts,and transplant kidney function has remained stable.CONCLUSION Stimulation of cell-mediated immunity against the human papilloma virus induced by the IL candida immunotherapy is thought to be a cause for wart resolution.With this therapy,whether it is necessary to augment the immunosuppression to prevent rejection is unclear as that may come with a risk of infectious complications.Larger,prospective studies in pediatric KT recipients are needed to explore these important issues.

关 键 词：WARTS Kidney transplantation CANDIDA IMMUNOTHERAPY PEDIATRIC Case report 

分 类 号：R69[医药卫生—泌尿科学]