title: [Disseminated aspergillosis in a patient with simultaneous pancreas and kidney transplant].
abstract: A 31-year-old woman suffering from diabetes type1 and terminal kidney disease, with simultaneously transplanted kidney and pancreas, developed an episode of acute organ rejection caused by antibodies. The management of organ rejection was complicated by cytomegalovirus viremia, with accompanying leukopenia and neutropenia. The patient also developed invasive aspergillosis of the lungs, which progressed and disseminated hematogenously to the thyroid gland and the skin. Due to resistance to classical antimycotic therapy, the patient was treated with a combination of caspofungin and variconazole. In the beginning of treatment, the effects of this combined therapy were not evident due to strong immunosuppression caused by antimycotic immunoglobulin, which the patient had been administered on her previous hospital stay to treat acute kidney transplant rejection caused by antibodies, as well as due to immunosuppression caused by tacrolimus, mycophenolate mofetil and prednisone. On combined therapy with antimycotic drugs and supportive therapy, the patient was completely cured.
authors.affiliation: Merkur University Hospital, Department of Internal Medicine, Zagreb, Croatia. apiljac@gmail.com
authors.forename: Ante
authors.initials: A
authors.lastname: Piljac
authors.forename: Dunja
authors.initials: D
authors.lastname: Fiala
authors.forename: Ingrid
authors.initials: I
authors.lastname: Prkacin
authors.forename: Dinko
authors.initials: D
authors.lastname: Skegro
authors.forename: Ivana Kovacević
authors.initials: IK
authors.lastname: Vojtusek
authors.forename: Sonja
authors.initials: S
authors.lastname: Gracin
authors.forename: Ika
authors.initials: I
authors.lastname: Kardum-Skelin
authors.forename: Dunja
authors.initials: D
authors.lastname: Sustercić
authors.forename: Mirjana
authors.initials: M
authors.lastname: Sabljar-Matovinović
authors.forename: Mladen
authors.initials: M
authors.lastname: Knotek
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D016035:Pancreas Transplantation
chemical_list: D007166:Immunosuppressive Agents