A renal transplant recipient with pulmonary tuberculosis and visceral leishmaniasis: review of superimposed infections and therapy approaches

Ersoy A., Gullulu M., Usta M., Ozcelik T., Ylmaz E., Uzaslan E., ...Daha Fazla

CLINICAL NEPHROLOGY, cilt.60, sa.4, ss.289-294, 2003 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 60 Sayı: 4
  • Basım Tarihi: 2003
  • Doi Numarası: 10.5414/cnp60289
  • Dergi Adı: CLINICAL NEPHROLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.289-294
  • Anahtar Kelimeler: kidney transplantation, visceral leishmaniasis, pulmonary tuberculosis, liposomal amphotericin treatment, LIPOSOMAL AMPHOTERICIN-B, FATAL LEISHMANIASIS, UNEXPLAINED FEVER, GRAFT RECIPIENT, RARE CAUSE, KALA-AZAR, PATIENT, KETOCONAZOLE, ALLOPURINOL, ANTIMONIATE
  • Bursa Uludağ Üniversitesi Adresli: Evet

Özet

Visceral leishmaniasis (VL) is an acute or subacute disease that is almost invariably fatal if untreated. It is a rare disease in renal transplant recipients and frequently reported together with other infectious agents. A 39-year-old renal transplant patient was admitted to hospital for elective coronary surgery. In the post-operative period, he developed spiking fever and non-productive cough and his general condition deteriorated. While he was taking medication for nonspecific pneumonia, a cavitary lesion occurred in his lung, and he had the diagnosis of pulmonary tuberculosis and antituberculous treatment was started. Despite treatment, his fever continued. As the patient developed pancytopenia and splenomegaly, a bone marrow aspiration was done. Evaluation of bone marrow aspirate indicated Leishmania parasites. He was successfully treated with a more intensive liposomal amphotericin (L-AmB). Complete cure was achieved during follow-up period of 10 months without clinical relapse. In the existence of fever and long-standing pancytopenia, VL should be suspected although the patient had another proved infection and did not live or visit an endemic area. L-AmB usage can be safely preferred for treatment of selected renal transplant recipients with VL as first-line therapy.