title: Fatal case of Aspergillus coinfection in a renal transplant recipient suffering from cytomegalovirus pneumonitis.
abstract: 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.
authors.affiliation: Department of Medicine, Tuen Mun Hospital, Hong Kong, China.
authors.forename: Yui-Pong
authors.initials: YP
authors.lastname: Siu
authors.forename: Kay-Tai
authors.initials: KT
authors.lastname: Leung
authors.forename: Matthew Ka-Hang
authors.initials: MK
authors.lastname: Tong
authors.forename: Yuk-Lung
authors.initials: YL
authors.lastname: Kwok
authors.forename: Pik-Kei
authors.initials: PK
authors.lastname: Wong
authors.forename: Tze-Hoi
authors.initials: TH
authors.lastname: Kwan
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents