Limits...
Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient.

Nandwani A, Jha PK, Duggal R, Kher V - Indian J Nephrol (2015 Nov-Dec)

Bottom Line: Cytomegalovirus (CMV) remains one of the most important pathogens.Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy.The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India.

ABSTRACT
Opportunistic infections are common in immunocompromised patients, such as solid organ transplant recipients. Both fungal and viral infections in posttransplant period increase morbidity and mortality. Cytomegalovirus (CMV) remains one of the most important pathogens. CMV disease may manifest as a nonspecific febrile syndrome or tissue-invasive infections. Zygomycosis is a rare infection, usually presents in rhino-cerebral, pulmonary and disseminated forms; gastrointestinal (GI) tract being a rare site of involvement. Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy. We report a renal transplant recipient, who developed gastric mucormycosis along with tissue invasive CMV disease, within 4 weeks of renal transplant and was diagnosed on the basis of upper GI endoscopy and gastric biopsy. The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

No MeSH data available.


Related in: MedlinePlus

Timeline of events during course of illness. (RTX - Rituximab, DFPP - Double filtration plasmapheresis, IL2RA - Interleukin 2 receptor antagonist, MP - Methyl prednisone, HD - Hemodialysis)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4663777&req=5

Figure 2: Timeline of events during course of illness. (RTX - Rituximab, DFPP - Double filtration plasmapheresis, IL2RA - Interleukin 2 receptor antagonist, MP - Methyl prednisone, HD - Hemodialysis)

Mentions: Patient was started on intravenous liposomal amphotericin B (3 mg/kg/day) and ganciclovir (2.5 mg/kg/day). Cyclosporin was stopped. After 2 days, he developed severe abdominal pain with hypotension. Computed tomography scan of the abdomen showed pneumoperitoneum and dehiscence of posterior wall of the stomach with leak of contents. Patient was taken for urgent exploratory laparotomy, which revealed 3 cm × 3 cm rent in the posterior wall of the stomach. Distal gastrectomy along with debridement and feeding jejunostomy was done. Postoperatively he remained on inotropic, ventilatory and dialytic support. Liposomal amphotericin B was continued along with ganciclovir and antibiotics. However, his condition progressively worsened, and he succumbed to the infection. The course of illness is shown in Figure 2.


Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient.

Nandwani A, Jha PK, Duggal R, Kher V - Indian J Nephrol (2015 Nov-Dec)

Timeline of events during course of illness. (RTX - Rituximab, DFPP - Double filtration plasmapheresis, IL2RA - Interleukin 2 receptor antagonist, MP - Methyl prednisone, HD - Hemodialysis)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663777&req=5

Figure 2: Timeline of events during course of illness. (RTX - Rituximab, DFPP - Double filtration plasmapheresis, IL2RA - Interleukin 2 receptor antagonist, MP - Methyl prednisone, HD - Hemodialysis)
Mentions: Patient was started on intravenous liposomal amphotericin B (3 mg/kg/day) and ganciclovir (2.5 mg/kg/day). Cyclosporin was stopped. After 2 days, he developed severe abdominal pain with hypotension. Computed tomography scan of the abdomen showed pneumoperitoneum and dehiscence of posterior wall of the stomach with leak of contents. Patient was taken for urgent exploratory laparotomy, which revealed 3 cm × 3 cm rent in the posterior wall of the stomach. Distal gastrectomy along with debridement and feeding jejunostomy was done. Postoperatively he remained on inotropic, ventilatory and dialytic support. Liposomal amphotericin B was continued along with ganciclovir and antibiotics. However, his condition progressively worsened, and he succumbed to the infection. The course of illness is shown in Figure 2.

Bottom Line: Cytomegalovirus (CMV) remains one of the most important pathogens.Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy.The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India.

ABSTRACT
Opportunistic infections are common in immunocompromised patients, such as solid organ transplant recipients. Both fungal and viral infections in posttransplant period increase morbidity and mortality. Cytomegalovirus (CMV) remains one of the most important pathogens. CMV disease may manifest as a nonspecific febrile syndrome or tissue-invasive infections. Zygomycosis is a rare infection, usually presents in rhino-cerebral, pulmonary and disseminated forms; gastrointestinal (GI) tract being a rare site of involvement. Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy. We report a renal transplant recipient, who developed gastric mucormycosis along with tissue invasive CMV disease, within 4 weeks of renal transplant and was diagnosed on the basis of upper GI endoscopy and gastric biopsy. The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

No MeSH data available.


Related in: MedlinePlus