Late-onset and atypical presentation of Pneumocystis carinii pneumonia in a renal transplant recipient

Li, Jordan; Yong, Tuck Yean; Grove, David I.; Coates, P. Toby

doi:10.1007/s10157-008-0079-9

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…PCP cases had a poorer renal function, more biopsy-proven rejections, and more frequent treatment with mycophenolate mofetil and less frequent treatment with interleukin-2 receptor antagonist. Li et al reported a later onset (5 years after renal transplantation) and atypical presentation of PCP pneumonia (14). The case had an indolent onset of pneumonia, which was similar to our case.…”

Section: Discussionsupporting

confidence: 87%

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Chiu

Wen

Shu

2017

Iran Red Crescent Med J

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Introduction: Pneumocystis carinii pneumonia remains a crucial cause of morbidity and mortality in organ transplant recipients. Pneumocystis carinii pneumonia occurs most frequently within the first 6 months post-transplant. Onset is generally fulminant, and typical symptoms include fever and productive cough accompanied with respiratory distress. Case Presentation: Here, we present a case of a patient who developed P. carinii pneumonia 18 years after renal transplantation and referred to Taichung Veteran General hospital in Taiwan in September 2015. The disease course was indolent without hypoxemia and dyspnea, mimicking walking pneumonia. The risk factors in our case contributing to P. carinii pneumonia included increased doses of immunosuppressants due to recent rejection, treatment with tacrolimus rather than cyclosporine, lymphopenia, and possibly the occurrence of urothelial carcinoma, implying an immune-deficient state. The inflammatory response of P. carinii pneumonia was not intense and gave rise to an indolent disease course. Conclusions: This case should remind clinicians that P. carinii pneumonia could present atypically in an indolent form many years following organ transplantation, especially when predisposing factors are present. Longer duration of P. carinii pneumonia prophylaxis, especially for high-risk patients such as those with potent immunosuppressive regimen, or those who received recent treatment for acute cellular or humeral rejection may be considered.

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Section: Discussionsupporting

confidence: 87%

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Chiu

Wen

Shu

2017

Iran Red Crescent Med J

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“…Two cases of PCP occurring nearly 3 years after transplantation were reported, after the administration of rituximab for refractory antibody‐mediated rejection . Another case reported the onset of PCP 5 years after a renal transplant . This patient was on sirolimus and also had a course of monoclonal anti‐CD3 antibody for an episode of acute rejection.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jirovecii pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection

Iqbal

Lim

et al. 2012

Transplant Infectious Dis

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Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia (PCP) is a rare but serious infection that usually occurs within a year after solid organ transplantation. PCP may occur after 1 year post transplantation, but the rate is reported to be very low. Studies have shown an association between cytomegalovirus (CMV) infection in solid organ transplant patients and an increased risk of opportunistic infection. This increased risk is thought to be a result of the immunomodulatory effects of the CMV infection. We present a case of PCP infection occurring 13 years after a renal transplantation. This occurred following a recurrent CMV infection while the patient was on low-dose immunosuppressants.

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“…Common symptoms of PCP include the subtle onset of progressive dyspnea, non‐productive cough, low‐grade fever, and arterial hypoxemia (3). The onset of symptoms may also be more fulminant, however, especially in the transplant population as compared with patients with human immunodeficiency virus infection (11). Despite adequate therapy with potent anti‐ P. jirovecii drugs such as trimethoprim–sulfamethoxazole (TMP–SMZ), mortality from PCP still approaches 50% in kidney graft recipients (4, 12).…”

mentioning

confidence: 99%

Late onset Pneumocystis pneumonia in renal transplantation after long‐term immunosuppression with belatacept

Haidinger

Hecking

Memarsadeghi

et al. 2009

Transplant Infectious Dis

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Interference with T-cell function increases the risk of infections, especially during the early post-transplant period. Belatacept, a costimulation blocker, is currently being tested in phase III clinical trials. Here we report a renal transplant recipient who received belatacept and developed severe Pneumocystis jirovecii pneumonia (PCP) with fatal superinfections 4 years post transplant. Cytomegalovirus infection preceded PCP, which typically occurs in overimmunosuppressed patients, but has not yet been reported under T-cell costimulation blockade in transplant patients. This case illustrates the possibility of excessive immunosuppression even with a lymphocyte-specific regimen.

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Late-onset and atypical presentation of Pneumocystis carinii pneumonia in a renal transplant recipient

Cited by 10 publications

References 18 publications

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Pneumocystis carinii Infection in a Renal Transplant Recipient Presented as Walking Pneumonia Occurring 18 Years After Transplantation: A Case Report

Pneumocystis jirovecii pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection

Late onset Pneumocystis pneumonia in renal transplantation after long‐term immunosuppression with belatacept

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