Nocardial infection in a renal transplant recipient on tacrolimus and mycophenolate mofetil.
Infection with Nocardia spp. is an uncommon but important cause of morbidity and mortality in organ transplant recipients. Cotrimoxazole prophylaxis against urinary tract infection and Pneumocystis carinii pneumonia in these patients usually prevents nocardial infection also. We report the case of a patient on tacrolimus and mycophenolate mofetil who developed drug-induced diabetes mellitus followed by nocardial brain infection. This infection occurred despite conventional cotrimoxazole prophylaxis. Physicians should be aware that newer, more potent and more diabetogenic immunosuppressive regimens may increase the risk of opportunistic infections such as nocardiosis, even in the presence of "adequate" antimicrobial preventive measures.
Magee
C C
CC
Laboratory of Immunogenetics and Transplantation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Halligan
R D
RD
Milford
E L
EL
Sayegh
M H
MH
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D003920:Diabetes Mellitus / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D009617:Nocardia Infections / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D009616:Nocardia asteroides / Q000302:isolation & purification; D009894:Opportunistic Infections / Q000517:prevention & control; D016559:Tacrolimus / Q000009:adverse effects*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009173:Mycophenolic Acid; D016559:Tacrolimus