Severe pulmonary nocardiosis in a kidney allograft recipient with a low immunological response.
A patient with severe pulmonary nocardiosis occurring in the early posttransplant period is presented. Three outstanding features characterized this case: 1) the failure to diagnose this rare opportunitistic pathogen by conventional detection methods necessitated open lung biopsy; 2) the initiation of trimethoprim-sulphamethoxazole therapy resulted in a dramatic clinical response; and 3) an allograft recipient with a low immunological response contracted nocardiosis. His immune status became apparent following pretransplant donor-specific blood transfusion tests, unresponsiveness to third-party transfusion and graft tolerance permitting the permanent withdrawal of azathioprine without graft function impairment.
D000328:Adult; D006789:Host vs Graft Reaction; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation; D008169:Lung Abscess / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D008297:Male; D009617:Nocardia Infections / Q000188:drug therapy / Q000209:etiology / Q000276:immunology*; D009616:Nocardia asteroides; D011014:Pneumonia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D011241:Prednisone / Q000009:adverse effects; D013420:Sulfamethoxazole / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use
D014295:Trimethoprim; D013420:Sulfamethoxazole; D011241:Prednisone