Cure of disseminated cryptococcal infection in a renal allograft recipient after addition of gamma-interferon to anti-fungal therapy.
The immunosuppressive regimens that are used in solid organ transplantation are potent inhibitors of Th0 as well as Th1 and Th2 cell-mediated immune responses. This predisposes patients to disseminated cryptococcal infections. Mortality in such patients remains very high despite advances in anti-fungal chemotherapy. We describe a case of disseminated cryptococcal disease in a renal allograft recipient that failed to respond to prolonged treatment with several anti-fungal drugs. However, addition of the immuno-modulator, interferon-gamma, resulted in the formation of granulomas and the resolution of his disease within 4-6 weeks. As we cannot find a similar example of combination therapy for disseminated cryptococcal disease in the solid organ transplant literature, we propose that interferon-gamma could be used in synergy with anti-fungal drugs to cure disseminated cryptococcal infections in solid organ transplant patients.
Department of Renal Medicine, Hammersmith Hospitals, London, UK. shaunsummers@hotmail.com
S A
SA
Summers
A
A
Dorling
J J
JJ
Boyle
S
S
Shaunak
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D003453:Cryptococcosis / Q000382:microbiology / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009181:Mycoses / Q000503:physiopathology / Q000821:virology; D014184:Transplantation, Homologous
D000935:Antifungal Agents; D000998:Antiviral Agents; D007371:Interferon-gamma