title: A heart transplant recipient lost due to Pneumocystis jiroveci pneumonia under trimethoprim-sulfamethoxazole prophylaxis: case report.
abstract: Infections in solid-organ transplant recipients are the most important causes of morbidity and mortality. A primary goal in organ transplant is the prevention or effective treatment of infection, which is the most common life-threatening complication of long-term immunosuppressive therapy. A 21-year-old woman who underwent heart transplant 3 years previous owing to dilated cardiomyopathy was referred to our hospital with symptoms of high fever and cough. The patient's history revealed that she had received a trimethoprim-sulfamethoxazole double-strength tablet each day for prophylactic purposes. On chest radiograph, pneumonia was detected, and in broncho-alveolar lavage sample, Pneumocystis jiroveci cysts were found. After diagnosing P. jiroveci pneumonia, trimethoprim-sulfamethoxazole was initiated at 20 mg/kg/d including intravenous trimethoprim in divided dosages every 6 hours. On the sixth day of therapy, she died in intensive care unit. In solid-organ transplant recipients, although antipneumocystis prophylaxis is recommended within the first 6 to 12 months after transplant, lifelong prophylaxis is also used in several settings. In addition, the physician should keep in mind that P. jiroveci pneumonia may develop in solid organ recipients, despite trimethoprim-sulfamethoxazole prophylaxis.
authors.affiliation: Adiyaman University, School of Health, Adiyaman, Turkey. tuncay100@hotmail.com
authors.forename: Tuncay
authors.initials: T
authors.lastname: Celik
authors.forename: Ender
authors.initials: E
authors.lastname: Gedik
authors.forename: Uner
authors.initials: U
authors.lastname: Kayabas
authors.forename: Yasar
authors.initials: Y
authors.lastname: Bayindir
authors.forename: Gazi
authors.initials: G
authors.lastname: Gulbas
authors.forename: Ahmet Kemal
authors.initials: AK
authors.lastname: Firat
authors.forename: Turkan
authors.initials: T
authors.lastname: Togal
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D017809:Fatal Outcome; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D045363:Pneumocystis carinii / Q000472:pathogenicity*; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination