Opportunistic Infections in Late Kidney Transplantation with Death Outcome: Case Report  

作　　者：Miriam Viviane Baron Carina Marangoni Michele Paula dos Santos Célia Regina Martins Korzenieski Vitória Pereira Itaquy Tais Michele Werle Gabriela Di Lorenzo Garcia Scherer Joice Nedel Ott Marcus Vinicius de Mello Pinto Janine Koepp Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Aline Ronis Sampaio Alexandre Sancho Danielle de Mello Florentino Bartira Ercília Pinheiro da Costa Miriam Viviane Baron;Carina Marangoni;Michele Paula dos Santos;Célia Regina Martins Korzenieski;Vitória Pereira Itaquy;Tais Michele Werle;Gabriela Di Lorenzo Garcia Scherer;Joice Nedel Ott;Marcus Vinicius de Mello Pinto;Janine Koepp;Carolina Gonçalves Pinheiro;Nathália Ken Pereira Iketani;Cristine Brandenburg;Aline Ronis Sampaio;Alexandre Sancho;Danielle de Mello Florentino;Bartira Ercília Pinheiro da Costa(Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Brazil;Coordination for the Improvement of Higher Education Personnel, Brazilia, Brazil;School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Brazil;Schoolof Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Brazil;CelulareInstitute, Rio de Janeiro, Brazil;University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil;Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC), São Paulo, Brazil;Hospital Beneficiente Portuguesa of Belém, Pará, Brazil;Dom José Institute of Education and Culture/University of Vale do Acaraú (IDJ/UVA), Ceará, Brazil;Unigranrio University, Rio de Janeiro, Brazil;Uniredentor University, Rio de Janeiro, Brazil)

机构地区：[1]Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Brazil [2]Coordination for the Improvement of Higher Education Personnel, Brazilia, Brazil [3]School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Brazil [4]Schoolof Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS), Porto Alegre, Brazil [5]CelulareInstitute, Rio de Janeiro, Brazil [6]University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil [7]Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC), Sã o Paulo, Brazil [8]Hospital Beneficiente Portuguesa of Belém, Pará, Brazil [9]Dom José Institute of Education and Culture/University of Vale do Acaraú (IDJ/UVA), Ceará, Brazil [10]Unigranrio University, Rio de Janeiro, Brazil [11]Uniredentor University, Rio de Janeiro, Brazil

出　　处：《Open Journal of Nephrology》2021年第2期171-182,共12页肾脏病（英文）

摘　　要：<i>Cytomegalovirus</i> (CMV) and <i>Pneumocystis jirovecii</i> fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus^® and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or <i>Pneumocystis jirovecii</i>. Treatment with Ganciclovir^® and Bactrim^® was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and <i>Pneumocystis jirovecii</i>. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and <i>Pneumocystis jirovecii</i>. Adjusting the doses of immunosuppressants to individual needs can be an imp<i>Cytomegalovirus</i> (CMV) and <i>Pneumocystis jirovecii</i> fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus^® and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or <i>Pneumocystis jirovecii</i>. Treatment with Ganciclovir^® and Bactrim^® was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and <i>Pneumocystis jirovecii</i>. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and <i>Pneumocystis jirovecii</i>. Adjusting the doses of immunosuppressants to individual needs can be an imp

关 键 词：Renal Transplantation INFECTIONS OPPORTUNISTIC Immunosuppressive Agent Cytomegalovirus Pneumocystis 

分 类 号：R69[医药卫生—泌尿科学]