Abstract

BENTO, Claudia et al. A diagnosis not to forget in a long -term kidney transplant: Pneumocystis pneumonia. Port J Nephrol Hypert [online]. 2014, vol.28, n.3, pp.260-264. ISSN 0872-0169.

Potential aetiologies of infection in kidney transplant patients are diverse, ranging from common community-acquired infectious diseases to uncommon opportunistic infections. Pneumocystis is a wellknown opportunistic fungus that can cause life-threatening pneumonia in kidney transplant patients mostly within the first 6 months post-transplantation. This en tity may occur after one year post-transplant, but the rate is very low. High immunosuppression, cytomegalovirus infection, previous history of acute rejection and poor GFR are risk factors for the occurrence of pneumocystis pneumonia (PCP) in kidney transplant patients. The treatment of choice is high-dose trimethoprim-sulfamethoxazol (TMP-SMX), reduction of immunosuppressive therapy and, in severe cases (defined by PaO2 < 70 mmHg or an arterial-alveolar gradient > 35 mmHg), association with steroids. We report a case of PCP 12.5 years after renal transplant. A 51-yearold male presented to the hospital with a 3-day history of asthenia, fever and genitourinary complains. Despite the initial treatment for cystitis he kept fever (> 38.5°C) and developed dry cough, hypoxaemia and rapidly progressive dyspnea. Physical examination revealed increased respiratory rate, tachycardia, cyanosis, wheezing and crackles on pulmonary auscultation. Radiographic alterations showed a bilateral interstitial infiltrates (not present on admission). On the 3th day, he was transferred to the intensive care unit and started non-invasive ventilation. The diagnosis was established by the identification of Pneumocystis in bronchoalveolar lavage. Treatment was made with high-dose intravenous TMP-SMX plus steroids and resulted in clinical improvement of the symptoms and complaints. Early diagnosis and prompt administration of empiric antimicrobial therapy are the cornerstones of successful treatment since the disease is associated with high mortality rate. This diagnosis should never be forgotten.

Keywords : Fever; high immunosuppression; kidney transplant; Pneumocystis jiroveci pneumonia; respiratory failure.

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