Fatal case of Aspergillus coinfection in a renal transplant recipient suffering from cytomegalovirus pneumonitis.
Cytomegalovirus (CMV) disease is common in postrenal transplant recipients, and may predispose the patients to secondary bacterial or fungal infections. However, simultaneous coinfection is rare and often makes diagnosis difficult. We report a case of CMV pneumonitis in a renal transplant recipient presenting with elevated CMV pp65 antigen level and abnormal chest radiograph. Despite potent and broad-spectrum antimicrobial therapy, his condition deteriorated rapidly - he soon went into respiratory failure, septic shock and died several days later. Transbronchial biopsy and bronchoalveolar lavage obtained before the patient's death showed evidence of invasive pulmonary aspergillosis with concomitant CMV pneumonitis. High index of suspicion and early and empirical initiation of antifungal therapy may be necessary for successful management of fulminant pneumonia in solid organ transplant recipients.
Siu
Yui-Pong
YP
Department of Medicine, Tuen Mun Hospital, Hong Kong, China.
Leung
Kay-Tai
KT
Tong
Matthew Ka-Hang
MK
Kwok
Yuk-Lung
YL
Wong
Pik-Kei
PK
Kwan
Tze-Hoi
TH
D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000150:complications* / Q000175:diagnosis
D007166:Immunosuppressive Agents