title: Severe lactic acidosis treated with prolonged hemodiafiltration in a disseminated histoplasmosis.
abstract: Infections with Histoplasma are rarely seen in immunocompromized patients. We report the case of a renal transplant recipient who presented with disseminated histoplasmosis 3.5 years after transplant. He presented severe lactic acidosis (LA), sepsis complicated by circulatory failure, renal failure, and liver dysfunction. We describe the successful use of continuous venovenous hemodiafiltration (CVVHDF) with regional citrate anticoagulation, treatment that stabilized our patient until infectious focus was identified and treated. The lactate was decreasing, concomitant with hemodynamic improvement, with reduction and suspension of the norepinephrine. The serum lactate level normalized 52 hours after CVVHDF initiated (from 28.9 to 2.2 mmol/L). Continuous renal replacement therapy was safely applied and can be recommended as an efficient method on adjuvant treatment of hyperlactatemia.
authors.affiliation: Division of Nephrology, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP. Brazil. rosilenemotta@hotmail.com
authors.forename: Rosilene Motta
authors.initials: RM
authors.lastname: Elias
authors.forename: Américo
authors.initials: A
authors.lastname: Cuvello-Neto
authors.forename: Maristela Carvalho
authors.initials: MC
authors.lastname: da Costa
mesh_terms: D000140:Acidosis, Lactic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D017583:Hemodiafiltration / Q000379:methods; D006660:Histoplasmosis / Q000150:complications* / Q000276:immunology* / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008107:Liver Diseases / Q000209:etiology; D008297:Male; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D012769:Shock / Q000209:etiology