title: Elderly kidney transplant recipient with intermittent fever: a case report of leishmaniasis with acute kidney injury during liposomal amphotericin B therapy.
abstract: We present a case report of visceral leishmaniasis in an elderly kidney transplant recipient (age, 73 years) with high intermittent fever in the 2 months before admission. Symptoms started 16 years after transplant. The patient received appropriate treatment with liposomal amphotericin and experienced transient increases in serum creatinine levels. Progression to dialysis was avoided with short duration of therapy (5 consecutive days, plus 1 more dose 1 week apart, a schedule alternative to 15-21 days [supported by the literature]) and a temporary reduction in tacrolimus exposure. After 4 months, recurrence of symptoms without other explanation required a second bone marrow aspirate; it revealed the persistence of amastigote forms. Visceral leishmaniasis is a potentially life-threatening infection; to the best of our knowledge, this is the oldest transplanted patient with a case of leishmaniasis described in the literature.
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: J A
authors.initials: JA
authors.lastname: Pedroso
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Paola Salerno
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Spagnoletti
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bertucci-Zoccali
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Zaccone
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Romagnoli
authors.affiliation: Renal Transplant Unit, Organ Transplant Ph.D. Program, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: fcitterio@rm.unicatt.it.
authors.forename: F
authors.initials: F
authors.lastname: Citterio
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000469:parasitology*; D008081:Liposomes; D008297:Male; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects; D016559:Tacrolimus / Q000627:therapeutic use; D066027:Transplant Recipients
chemical_list: D000981:Antiprotozoal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D000666:Amphotericin B; D003404:Creatinine; D016559:Tacrolimus