scholarly journals Assessing causality by means of the Naranjo scale in a paediatric patient with life threatening respiratory failure after alemtuzumab administration: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nori J. L. Smeets ◽  
Ruud J. R. Eijk ◽  
Saskia N. de Wildt ◽  
Charlotte M. H. H. T. Bootsma-Robroeks
Keyword(s):  
Respiratory Failure ◽  
Clinical Reasoning ◽  
Causality Assessment ◽  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
Added Value ◽  
Severe Reaction ◽  
Solid Organ ◽  
Life Threatening ◽  
Alveolar Oedema

Abstract Background Alemtuzumab is a T cell depleting antibody agent used as induction immunosuppressant therapy in solid organ transplant recipients. In addition, it is being increasingly used to treat severe or glucocorticoid-resistant graft rejection. Despite the effectiveness of the treatment, severe adverse events have been reported related to alemtuzumab administration. We present a similar event illustrating the severity of this adverse drug reaction (ADR) and we highlight the structure causality assessment provides in approaching such a case. Case presentation We report a case of life-threatening respiratory failure after alemtuzumab administration in a 17 year old paediatric kidney transplant recipient. He developed near fatal severe respiratory and circulatory failure based on acute respiratory distress syndrome (ARDS) with diffuse alveolar oedema and haemoptysis hours after his second alemtuzumab administration. As it was questionable whether alemtuzumab could be regarded as the origin of his reaction and in order to assess the causality of this reaction as well as to structure clinical reasoning, we applied a widely used ADR probability scale to systematically review our case. Discussion and conclusions Our case shows a severe ADR after alemtuzumab administration. It illustrates the importance of proper causality assessment, the structure it provides and the benefit of a clinical pharmacology consultation when a severe reaction is suspected to be an ADR. By taking our case as an example, we demonstrate the added value of structured causality assessment to clinical reasoning and in generating differential diagnoses.

scholarly journals FusariumInfection in a Kidney Transplant Recipient Successfully Treated with Voriconazole

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ahmed M. Alkhunaizi ◽  
Ali M. Bazzi ◽  
Ali A. Rabaan ◽  
Elwaleed A. Ahmed
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
High Mortality ◽  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Fusariuminfections in solid-organ transplant recipients are rare and carry high mortality. We report a case of a kidney transplant recipient who developed infection withFusariumspecies. The patient received treatment with oral voriconazole for five months with good response.

scholarly journals Sustained Trichodysplasia Spinulosa Polyomavirus Viremia Illustrating a Primary Disseminated Infection in a Kidney Transplant Recipient

2021 ◽  
Vol 9 (11) ◽  
pp. 2298
Author(s):  
Marie-Céline Zanella ◽  
Damien Pastor ◽  
Mariet C. W. Feltkamp ◽  
Karine Hadaya ◽  
Samuel Cordey ◽  
...  
Keyword(s):  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
High Viral Load ◽  
Skin Lesions ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Viral Loads ◽  
Anal Swab ◽  
Solid Organ Transplant Recipients

Novel human polyomaviruses (HPyV) have been recently identified in solid organ transplant recipients. Trichodysplasia spinulosa (TS) is a rare disease associated with immunosuppression and induced by a polyomavirus (TSPyV). We report here a case of primary and disseminated TSPyV infection after kidney transplantation with extensive skin lesions, sustained viremia, and high viral loads in urine specimens, anal, nasal and throat swabs, assessed via specific real-time PCR for TSPyV during a follow-up period of 32 months after transplantation. The detection of TSPyV with a high viral load in respiratory and anal swab samples is compatible with viral replication and thus may suggest potential respiratory and oro-fecal routes of transmission.

Rashes associated with transplantations

2020 ◽  
pp. 535-538
Keyword(s):  
Fungal Infections ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Host Immunity ◽  
Solid Organ ◽  
Graft Versus Host ◽  
Gingival Hypertrophy ◽  
Life Threatening ◽  
Transplant Complications

Dermatological manifestations following transplantation are common but important to recognize and diagnose since they may be severe and life-threatening if not adequately and promptly treated. This chapter provides a systematic overview of the types of skin disease that may be encountered in children that have received a haematological or solid organ transplant. Complications relating to immunosuppression include an increased susceptibility to bacterial, viral, and fungal infections which may be significantly more virulent and hazardous in the context of reduced host immunity. Immune suppressant drugs may also cause drug rashes and aesthetic complications such as acne, hypertrichosis, or gingival hypertrophy, as well as longer-term risks from the development of malignancy. It is also important to recognize the range of mucocutaneous signs of acute and chronic graft versus host disease following bone marrow and solid organ transplantation which, again, may be severe and associated with significant morbidity and mortality.

Nocardia spp.: A Rare Cause of Pneumonia Globally

2020 ◽  
Vol 41 (04) ◽  
pp. 538-554
Author(s):  
Joseph P. Lynch ◽  
Gail Reid ◽  
Nina M. Clark
Keyword(s):  
Susceptibility Testing ◽  
Organ Transplant ◽  
Clinical Manifestations ◽  
Community Acquired Pneumonia ◽  
Solid Organ ◽  
In Vitro Susceptibility ◽  
Timely Initiation ◽  
Life Threatening ◽  
Initiation Of Therapy

AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

Invasive pulmonale Aspergillose

2019 ◽  
Vol 144 (17) ◽  
pp. 1218-1222
Author(s):  
Hanna Matthews ◽  
Holger Rohde ◽  
Dominic Wichmann ◽  
Stefan Kluge
Keyword(s):  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Severe Neutropenia ◽  
Solid Organ ◽  
First Line ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem ◽  
Severe Influenza ◽  
Life Threatening

AbstractInvasive pulmonary aspergillosis is a life-threatening disease occurring in patients with severe immunosuppression. It is classically associated with severe neutropenia following hematopoietic stem cell transplantation, but other risk factors include COPD, corticosteroid therapy, solid organ transplant, liver failure and preceding severe influenza infection. Due to the high mortality of the disease, rapid diagnosis and treatment are crucial. Diagnosis is based on CT scan and bronchoscopy including microscopy, culture and galactomannan detection in BAL. Histopathology remains the gold standard diagnosis but is not feasible in many cases. First line treatment is voriconazole, new recommendations also support the triazole isavuconazole.

scholarly journals A Rare Case of Sino-Orbital Invasive Aspergillosis in a Kidney Transplant Recipient

2020 ◽  
pp. 1-4
Author(s):  
Adela D. Mattiazzi ◽  
Adela D. Mattiazzi ◽  
Camilo A. Cortesi ◽  
Efrat Saraf Lavi ◽  
Giselle Guerra ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Rare Case ◽  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
Orbital Exenteration ◽  
Transplant Recipients ◽  
Significant Morbidity ◽  
Life Threatening ◽  
Life Threatening Complication

Invasive sino-orbital aspergillosis is an uncommon but potentially life-threating complication of kidney transplantation. Here we report a case of a patient with invasive aspergillus fumigatus sinusitis extending into the orbit in a kidney transplant recipient who was successfully treated with voriconazole and surgical debridement without requiring orbital exenteration. This case illustrates a rare but life-threatening complication of immunosuppression that highlights the importance of suspecting and promptly recognizing fungal infection of the sinuses in vulnerable organ transplant recipients in order to avoid significant morbidity and mortality.

Dapsone for Pneumocystis jirovecii pneumonia prophylaxis – applying theory to clinical practice with a focus on drug interactions

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Carmela Emma Corallo ◽  
John Coutsouvelis ◽  
Susan Morgan ◽  
Orla Morrissey ◽  
Sharon Avery
Keyword(s):  
Organ Transplant ◽  
Cost Effective ◽  
Chemotherapeutic Agents ◽  
Pneumocystis Jirovecii ◽  
Haematopoietic Stem Cell ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
Substantial Risk

AbstractPneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised individuals. The incidence can be as high as 80% in some groups but can be reduced to less than 1% with appropriate prophylaxis. HIV-infected patients with a low CD4 count are at the highest risk of PJP. Others at substantial risk include haematopoietic stem cell and solid organ transplant recipients, those with cancer (particularly haematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. Trimethoprim-sulfamethoxazole is an established first-line line agent for prevention and treatment of PJP. However, in some situations, this medication cannot be used and dapsone is considered a suitable cost-effective second line agent. However, information on potential interactions with drugs commonly used in immunosuppressed patients is lacking or contradictory. In this this article we review the metabolic pathway of dapsone with a focus on interactions and clinical significance particularly in patients with haematological malignancies. An understanding of this process should optimise the use of this agent.

scholarly journals JC Polyomavirus and Transplantation: Implications for Virus Reactivation after Immunosuppression in Transplant Patients and the Occurrence of PML Disease

2021 ◽  
Vol 2 (1) ◽  
pp. 37-48
Author(s):  
James E. K. Hildreth ◽  
Donald J. Alcendor
Keyword(s):  
Inflammatory Responses ◽  
Rare Complication ◽  
Organ Transplant ◽  
Solid Organ ◽  
Virus Reactivation ◽  
Jc Polyomavirus ◽  
Hematological Disorders ◽  
Transplant Patients ◽  
Immunosuppressed Patients ◽  
Life Threatening

The JC polyomavirus (JCPyV/JCV) is a member of the Polyomaviridae family and is ubiquitious in the general population, infecting 50–80% of individuals globally. A primary infection with JCV usally results in an asymptomatic, persistent infection that establishes latency in the renourinary tract. Reactivation from latency via iatrogenic immununosuppression for allograft transplantation may result in organ pathology and a potential life-threatening neuropathological disease in the form of progressive multifocal leukoencephalopathy (PML). Currently, no treatment exists for PML, a rare complication that occurs after transplantation, with an incidence of 1.24 per 1000 persons a year among solid organ transplant patients. PML is also observed in HIV patients who are immununosuppressed and are not receiving antiretroviral therapy, as well as individuals treated with biologics to suppress chronic inflammatory responses due to multiple sclerosis, Crohn’s disease, non-Hodgkin’s lymphoma, rheumatoid arthritis, and other autoimmune-mediated hematological disorders. Here, we describe the proposed mechanisms of JCV reactivation as it relates to iatrogenic immunosuppression for graft survival and the treatment of proinflammatory disease, such as biologics, proposed trafficking of JCV from the renourinary tract, JCV central nervous system dissemination and the pathology of PML in immunosuppressed patients, and potential novel therapeutics for PML disease.

scholarly journals Comprehensive Immune Profiling of a Kidney Transplant Recipient With Peri-Operative SARS-CoV-2 Infection: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Karen R. Sherwood ◽  
David D. M. Nicholl ◽  
Franz Fenninger ◽  
Vivian Wu ◽  
Paaksum Wong ◽  
...  
Keyword(s):  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Limited Data ◽  
Immunological Monitoring ◽  
Post Transplant ◽  
Robust Immune Response ◽  
Solid Organ Transplant Recipients ◽  
Immune Profiling

To date there is limited data on the immune profile and outcomes of solid organ transplant recipients who encounter COVID-19 infection early post-transplant. Here we present a unique case where the kidney recipient’s transplant surgery coincided with a positive SARS-CoV-2 test and the patient subsequently developed symptomatic COVID-19 perioperatively. We performed comprehensive immunological monitoring of cellular, proteomic, and serological changes during the first 4 critical months post-infection. We showed that continuation of basiliximab induction and maintenance of triple immunosuppression did not significantly impair the host’s ability to mount a robust immune response against symptomatic COVID-19 infection diagnosed within the first week post-transplant.

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