Severe lactic acidosis treated with prolonged hemodiafiltration in a disseminated histoplasmosis.
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.
Elias
Rosilene Motta
RM
Division of Nephrology, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, SP. Brazil. rosilenemotta@hotmail.com
Cuvello-Neto
Américo
A
da Costa
Maristela Carvalho
MC
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