Cytomegalovirus and Aspergillus spp. coinfection in organ transplantation: A case report and review of the literature

Solak Y., Biyik Z., Cizmecioglu A., Genc N., Ozbek O., Gaipov A., Yeksan M.

Research output: Contribution to journalArticlepeer-review

Abstract

With the advent of potent immunosuppressive options, acute rejection episodes have decreased at the expense of increased incidence of opportunistic infections in solid organ recipients. In the absence of any preventive therapy, 30-75 % of transplant recipients develop cytomegalovirus (CMV) infection. Candida spp. and Aspergillus spp. account for more than 80 % of invasive fungal infections in solid organ recipients. This co-occurrence of two commonly seen opportunistic infections may end up in fatality. Here, we present a case of concomitant Aspergillus spp. and CMV infection and discuss the relevant literature. A 54-year-old male patient presented with fever, shortness of breath, and chest pain on the 9th posttransplant week after renal transplantation. CMV-DNA by polymerase chain reaction (PCR) was 1,680,000 copies/ml, thus, valganciclovir dose was increased. There were inspiratory crackles at both lung bases, and chest computed tomography (CT) revealed multiple fungal balls throughout the right lung. Galactomannan antigen was positive, and voriconazole and other antimicrobials were subsequently added to the treatment. At the end of the therapy, on control CT, pneumonic consolidation had disappeared, sputum cultures didn't show Aspergillus spp., and CMV-DNA reduced to 700 copies/ml. The patient showed a favorable clinical response to combined treatment; fever, dyspnea, and pleuritic chest pain disappeared. Both CMV disease and aspergillosis may present as pulmonary disease; thus, the characterization of one may not preclude the search for the other and the timely initiation of treatment is of paramount importance for good outcomes. © 2012 Japanese Society of Nephrology.
Original languageEnglish
Pages (from-to)59-67
Number of pages9
JournalCEN Case Reports
Volume2
Issue number1
DOIs
Publication statusPublished - 2013

Keywords

  • Doppler flowmetry
  • adult
  • amphotericin B
  • article
  • aspergillosis
  • case report
  • community acquired pneumonia
  • computer assisted tomography
  • corticosteroid
  • cytomegalovirus infection
  • deep vein thrombosis
  • dyspnea
  • fever
  • galactomannan
  • ganciclovir
  • hospitalization
  • human
  • imipenem
  • itraconazole
  • loading drug dose
  • low molecular weight heparin
  • lung biopsy
  • malaise
  • male
  • methylprednisolone
  • mixed infection
  • mycophenolate mofetil
  • organ transplantation
  • piperacillin plus tazobactam
  • pneumothorax
  • polymerase chain reaction
  • prednisone
  • priority journal
  • tacrolimus
  • terbinafine
  • thorax pain
  • thymocyte antibody
  • tigecycline
  • urine culture
  • valaciclovir
  • valganciclovir
  • voriconazole

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