Case Reports in Transplantation https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Primary Cytomegalovirus Infection Causing Guillain-Barré Syndrome in a Living Renal Allograft Recipient Mon, 20 Nov 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/7264793/ Guillain-Barré Syndrome (GBS) is a common acute autoimmune polyneuropathy in adults. There have been few reported cases of Guillain-Barré Syndrome associated with active cytomegalovirus (CMV) infection in renal transplant recipients. Here we present a case of active CMV viremia inducing Guillain-Barré Syndrome in a renal transplant recipient. We discuss the treatment regimen utilized. Furthermore, we performed a review of the literature and discuss the cases of CMV induced GBS in renal transplant recipients. Massini Merzkani, Ezra Israel, and Mala Sachdeva Copyright © 2017 Massini Merzkani et al. All rights reserved. Unusual Pathology in a Kidney from a Heart-Transplant Patient Sun, 05 Nov 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/1084718/ Acute kidney injury (AKI) is often observed after heart transplantation. In this setting, acute tubular necrosis is the main histological finding on kidneys. We report the unusual pathology found in a kidney from a heart-transplant patient. The patient experienced several hemodynamic insults, massive transfusion, and implantation of a mechanical circulatory-support device before heart transplantation: there was prolonged AKI after transplantation. A kidney biopsy revealed acute tubular necrosis and renal hemosiderosis, which was probably related to the transfusion and to mechanical circulatory-support device-induced intravascular hemolysis. Assessment of iron during resuscitation could have prevented, at least partly, AKI. Marie Larcher, Audey Delas, Clément Delmas, Olivier Cointault, Camille Dambrin, Arnaud Del Bello, and Nassim Kamar Copyright © 2017 Marie Larcher et al. All rights reserved. Gallstone Pancreatitis: A Common but Often Overlooked Cause of Abdominal Pain in Post-Liver-Transplant Patients Sun, 22 Oct 2017 07:57:49 +0000 http://www.hindawi.com/journals/crit/2017/6047046/ Introduction. In general population, gallstone pancreatitis is the most common cause of pancreatitis. However, there are very few literatures that address this topic in post-liver-transplant patients. Clinical Case. A 69-year-old female who had a liver transplant in 2015 due to hepatocellular carcinoma and nonalcoholic steatohepatitis (NASH) cirrhosis. She had a recent episode of acute cellular rejection that was treated with high dose methylprednisolone 1 week prior to admission. She presented with severe epigastric abdominal pain associated with nausea and vomiting. Her laboratory studies showed significantly elevated serum lipase, AST, and ALT from her baseline. She underwent urgent Endoscopic Ultrasound (EUS) with Endoscopic Retrograde Cholangiopancreatography (ERCP) that showed common bile duct stone that was extracted. Discussion. Biliary sludge and stones accounted for 22% of late onset acute pancreatitis after liver transplant. Corticosteroids have been identified as one of the potential causes of drug-induced pancreatitis. However, she is more likely to have gall stone pancreatitis since she also had dilated common bile duct and intrahepatic duct. In addition, there was CBD stone noted on ERCP. Conclusion. Acute gallstone associated pancreatitis after liver transplant is not uncommon. Patients generally have good outcomes. Further prospective studies are warranted. Napatt Kanjanahattakij, Kamolyut Lapumnuaypol, Sanna Fatima, and Eyob Feyssa Copyright © 2017 Napatt Kanjanahattakij et al. All rights reserved. Reconstruction of a Damaged Lower Polar Artery for Kidney Transplantation Using Tubularised Donor Aorta Mon, 16 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/3532473/ Introduction. Live donors, extended donor criteria, and the maximum usage of organs with anatomical variants are some of the mechanisms used to increase the number of organs available. Case. We present the case of a kidney transplant, in which the organ had an iatrogenic injury to a lower pole arterial branch during retrieval. The donor was a 35-year-old male (DCD, Maastricht III). The right kidney was accepted; it had three veins in a single cava patch and three renal arteries, the main artery with aorta patch that is 8 cm long. A small lower pole artery was sectioned during retrieval surgery at approximately 1 cm from its origin as well as a third small mid-lower pole artery. The lower pole damaged artery was reconstructed using tubularised aorta patch to a total length of 5 cm. No additional donor vessels had been sent. After construction of the tubulised aorta, E-E anastomosis to the damaged polar artery was done with interrupted 7-0 Prolene sutures. Conclusion. While the waiting list for a kidney continues to rise and we continue to have organ shortness, vascular retrieval injury should not be an absolute contraindication for transplant. A. J. Vicéns-Morton, C. Callaghan, and J. Olsburgh Copyright © 2017 A. J. Vicéns-Morton et al. All rights reserved. Posttransplant Lymphoproliferative Disease Presenting as an Extracranial Mass Wed, 11 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/6401086/ Posttransplant lymphoproliferative disease is a serious complication following stem cell and solid organ transplantation. Early recognition of the disease is important in facilitating timely therapy and improving long-term outcomes. We report a renal transplant recipient presenting with an extracranial frontoparietal soft tissue mass that was subsequently diagnosed as a B-cell lymphoma. The patient was treated successfully with immunosuppression reduction, anti-CD20 monoclonal antibody therapy, and cytotoxic chemotherapy. Our case highlights the importance of recognizing soft tissue masses in the head and neck as a potential clinical manifestation of PTLD in solid organ transplant recipients. Reuben J. Arasaratnam and Alejandro Restrepo Copyright © 2017 Reuben J. Arasaratnam and Alejandro Restrepo. All rights reserved. Incidental Eosinophilic Chromophobe Renal Cell Carcinoma in Renal Allograft Mon, 09 Oct 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/4232474/ The incidence of renal cell carcinoma (RCC) in renal allograft in transplant recipients is 0.22–0.25%. De novo clear cell, papillary, and chromophobe RCCs and RCCs with sarcomatoid differentiation originating in renal allograft have been reported. Routine surveillance for graft tumours is not routinely practiced and these tumours are commonly asymptomatic and incidentally discovered. We describe a case of incidental, eosinophilic chromophobe RCC in a 31-year-old, long-term renal transplant male recipient, who presented with acute gastroenteritis 11 years after transplantation. The graft was nonfunctional at the time of presentation. Abdominal ultrasound and computed tomography scan demonstrated 1.8 cm well-defined, round enhancing lesion, confined to the renal allograft and suspicious for malignancy. Pathological examination of graft nephrectomy specimen showed gross, histopathological, and immunohistochemical features of eosinophilic chromophobe RCC. Fifty-five months after surgery, the patient was alive and free of malignancy. To the best of our knowledge, only five chromophobe RCCs originating in a renal allograft were previously described in English literature. We suggest that chromophobe RCC should be considered in the differential diagnosis of renal allograft mass, including eosinophilic tumours, and emphasise the importance of periodic screening of renal allograft in all renal transplant recipients. Abdullah Alharbi, Maram S. Al Turki, Noura Aloudah, and Khaled O. Alsaad Copyright © 2017 Abdullah Alharbi et al. All rights reserved. Collecting Duct Carcinoma of the Native Kidney in a Renal Transplant Recipient Thu, 14 Sep 2017 07:20:48 +0000 http://www.hindawi.com/journals/crit/2017/4527104/ Collecting duct carcinoma (CDC) is a rare and aggressive form of renal cell carcinoma (RCC) arising from the epithelium of Bellini’s duct. It presents earlier in life and has a poorer prognosis than the clear-cell type. Historically, immunosuppressed renal transplant patients are more likely to develop malignancies than the general population. We report a case of CDC of the native kidney in a 59-year-old man who initially underwent kidney transplantation five years before the time of presentation. To our knowledge, CDC in the setting of renal transplant and long-term immunosuppression has not been previously described. Ian Zheng, Mahmoud Alameddine, Yaohong Tan, Zhobin Moghadamyeghaneh, Joshua S. Jue, Ali Yusufali, Ahmed Farag, and Gaetano Ciancio Copyright © 2017 Ian Zheng et al. All rights reserved. Unusual Manifestations of Acute Cytomegalovirus Infection in Solid Organ Transplant Hosts: A Report of Two Cases Mon, 11 Sep 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/4916973/ Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality in immunocompromised hosts. Tissue-invasive CMV disease causing ulcerative skin disease or esophageal necrosis is rare. We herein describe two cases: a 47-year-old renal and pancreas transplant recipient who presented with skin ulcerations on his elbow and a 50-year-old renal transplant recipient who presented with acute esophageal necrosis. In both, tissue biopsy revealed CMV inclusion bodies by immunohistochemical staining of infected endothelial and mucosal cells. Ganciclovir was given to both cases and full remission occurred. Due to the varying presentations of acute CMV infection in immunosuppressed hosts, high suspicion and early tissue biopsy are vital for proper diagnosis and treatment when any suspicious cutaneous or mucosal manifestations are present. Alfredo Mena Lora, Justin Khine, Nadia Khosrodad, and Vijay Yeldandi Copyright © 2017 Alfredo Mena Lora et al. All rights reserved. Tacrolimus Aggravated Tube Feeding Syndrome with Acute Renal Failure in a Pediatric Liver Transplant Recipient Sun, 20 Aug 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/7345680/ Acute renal failure can be caused by calcineurin inhibitors (CNIs), due to arteriolopathy and altered tubular function. Within this context, we present the case of a 14-month-old liver transplant recipient who suffered an acute polyuric renal failure during a short episode of hypercaloric feeding. In our case, CNI-induced distal RTA led to nephrocalcinosis and therefore to secondary nephrogenic diabetes insipidus. The diet with high renal solute load consequently resulted in an acute polyuric renal failure with severe hypernatremic dehydration. In conclusion, a hypercaloric diet in children with potentially impaired renal function due to therapy with CNIs requires precise calculation of the potential renal solute load and the associated fluid requirements. R. Kula, M. Melter, J. Kunkel, C. Dörfler, S. Alikadic, B. Knoppke, and R. Zant Copyright © 2017 R. Kula et al. All rights reserved. Diagnostic Lessons from a Complex Case of Postintestinal Transplantation Enteropathy Sun, 06 Aug 2017 09:26:46 +0000 http://www.hindawi.com/journals/crit/2017/2498423/ Recent advances in the field of intestinal transplantation have been mitigated by the incidence of allograft rejection. In such events, early identification and appropriate timing of antirejection therapy are crucial in retaining graft function. We present the case of a patient who suffered severe postintestinal transplantation allograft enteropathy, primarily characterized by extensive mucosal ulcerations, and was refractory to all conventional therapy. This progressed as chronic rejection; however crucially this was not definitively diagnosed until allograft function had irreversibly diminished. We argue that the difficulties encountered in this case can be attributed to the inability of our current array of investigative studies and diagnostic guidelines to provide adequate clinical guidance. This case illustrates the importance of developing reliable and specific markers for guiding the diagnosis of rejection and the use of antirejection therapeutics in this rapidly evolving field of transplant surgery. Cian Wade, Philip Allan, Elena Collantes, Srikanth R. Reddy, Peter J. Friend, and Georgios Vrakas Copyright © 2017 Cian Wade et al. All rights reserved. Angiosarcoma Developing in an Arteriovenous Fistula after Kidney Transplantation Sun, 06 Aug 2017 06:29:51 +0000 http://www.hindawi.com/journals/crit/2017/2426859/ After transplantation, the main concerns involve immunosuppression, the prevention and treatment of infections and graft rejection, and tumor prevention. Sometimes the complications that may appear in the arteriovenous fistula are neglected following kidney transplantation. This is the reason why we are presenting the case of an angiosarcoma developing in an arteriovenous fistula after kidney transplantation. It is a very rare case and our goal is to create an alarm so that after kidney transplantation clinicians do not lose sight of the patients’ previous history. Bruna Natacha Leite Costa, Constantino Fernández Rivera, Maria Calvo Rodríguez, Teresa Hermida Romero, Andrés López Muñiz, Tamara Ferreiro Hermida, Felipe Sacristán Lista, Pilar Iglesias Díaz, and Ángel Alonso Hernández Copyright © 2017 Bruna Natacha Leite Costa et al. All rights reserved. Spontaneous Renal Allograft Rupture Caused by Acute Tubular Necrosis: A Case Report and Review of the Literature Thu, 20 Jul 2017 07:00:33 +0000 http://www.hindawi.com/journals/crit/2017/9158237/ Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. RAR is frequently associated with acute rejection, but other causes like renal vein thrombosis and acute tubular necrosis have also been observed. Most commonly a graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. Herein, we describe a rare case of spontaneous renal allograft rupture in the early posttransplant period due to acute tubular necrosis. A 42-year-old male, living donor renal allograft recipient, experienced RAR on the sixth posttransplant day. Surgical exploration showed two lacerations of 10 cm and 5 cm length at the upper and mid pole of the kidney. Histologically, the graft demonstrated acute tubular injury; no features of humoral or cellular rejection were identified. The successful management of this complication resulted in the salvage of the patient and the graft. This case demonstrates that early diagnosis and prompt treatment of a life-threatening RAR can salvage the graft. Deepak Shankar Ray and Sharmila Thukral Copyright © 2017 Deepak Shankar Ray and Sharmila Thukral. All rights reserved. Skin-Limited Graft-versus-Host Disease after Pancreatic Transplantation Tue, 18 Jul 2017 09:00:21 +0000 http://www.hindawi.com/journals/crit/2017/4823870/ Introduction. The phenomenon of graft-versus-host disease, a solid organ transplant recipient, is a rare development with a very poor prognosis. Case Presentation. A 40-year-old woman with type 1 diabetes developed cutaneous graft-versus-host disease following second pancreas transplantation. Conclusion. The development of a nonspecific rash in the early posttransplant period following a pancreas transplant warrants suspicion for graft-versus-host disease. Muneeb Ilyas, Elika Hoss, David J. DiCaudo, Hasan Khamash, Mark R. Pittelkow, and Amit Sharma Copyright © 2017 Muneeb Ilyas et al. All rights reserved. Successful Use of Ectopic Pelvic Kidney for Living Related Donation Technical Aspects and Literature Review Sun, 04 Jun 2017 06:47:11 +0000 http://www.hindawi.com/journals/crit/2017/8286257/ Ectopic pelvic kidneys can provide an additional source of organs for transplantation. They are often excluded from donation in living donation programs mainly due to aberrant vascular and urinary anatomies. We present a donor with an ectopic left kidney, who successfully donated his kidney. The use of ectopic pelvic kidney for living kidney transplantation is a highly demanding surgical procedure but after extensive preoperative investigation in high volume centers with surgical expertise in vascular reconstruction and access surgery, ectopic pelvic kidneys should not be a contraindication for donation and should be considered as a viable option. R. C. Minnee, H. J. A. N. Kimenai, J. van de Wetering, and J. N. M. Ijzermans Copyright © 2017 R. C. Minnee et al. All rights reserved. IVIG Associated Aseptic Meningitis in a Renal Transplant Patient Tue, 23 May 2017 07:31:39 +0000 http://www.hindawi.com/journals/crit/2017/6962150/ The management of antibody-mediated rejection in renal transplant recipients involves plasmapheresis with IVIG. Aseptic meningitis is a rare adverse effect of IVIG therapy and is a diagnosis of exclusion. We report a case of a renal transplant patient who developed IVIG associated aseptic meningitis in the context of management of antibody-mediated rejection, four years after transplantation. Tamara Wanigasekera, Rachel J. Grainger, Donal J. Sexton, and Colm Magee Copyright © 2017 Tamara Wanigasekera et al. All rights reserved. Duodenal Graft Perforation after Simultaneous Pancreas-Kidney Transplantation Wed, 05 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/5681251/ A 45-year-old woman with type 1 diabetes and chronic renal failure on dialysis underwent simultaneous pancreas-kidney transplantation from a brain dead donor. On postoperative day 15, acute generalized peritonitis was diagnosed and emergency laparotomy was performed. Perforation of the donor duodenum was found, which had apparently resulted from duodenal compression by the tip of the intestinal fistula tube placed for decompression. The perforation was sutured and the intestinal fistula tube was exchanged. Following this, perforation repeatedly recurred at the same site and open repair at laparotomy was required a total of four times. The fourth operation involved both suturing the perforation and covering it with ileum, after which there was no further recurrence. The patient was discharged on posttransplantation day 219, with the pancreas and kidney grafts both functioning well. This report presents a rare complication of simultaneous pancreas-kidney transplantation. Akihito Sannomiya, Ichiro Nakajima, Yuichi Ogawa, Kotaro Kai, Ichiro Koyama, and Shohei Fuchinoue Copyright © 2017 Akihito Sannomiya et al. All rights reserved. Successful Treatment of Recurrent Pulmonary Mucormycosis in a Renal Transplant Patient: A Case Report and Literature Review Mon, 13 Mar 2017 06:54:54 +0000 http://www.hindawi.com/journals/crit/2017/1925070/ Background. We describe the unusual case of a recently transplanted cadaveric renal transplant recipient who presented with recurrent pulmonary mucormycosis. Case Report. An 18-year-old man with end stage renal disease secondary to congenital renal agenesis status after cadaveric kidney transplant 4 months before presented with acute onset of fever, hemoptysis, and back pain. The patient underwent an emergent left lower lobectomy due to the critical nature of his illness. He was also treated with amphotericin with resolution of his symptoms. One week later, he had evidence of recurrent disease on imaging with a surgical site infection. He underwent reexploration with evacuation of an empyema and debridement of a surgical site infection. He was continued on IV antifungal therapy with isavuconazonium and amphotericin. Radiographic clearance of disease with three months of treatment was apparent with no evidence of recurrence at seven-month follow-up. Discussion. Opportunistic infections in solid organ transplant patients represent a significant source of morbidity and mortality. Most patients are treated with prophylactic anti-infective agents. However, rare infections such as pulmonary mucormycosis remain a risk. The transplant physician must be aware of these uncommon infections and their treatment strategies, including the management of uncommon recurrent disease. Morgan S. Martin, Alison A. Smith, Monica Lobo, and Anil S. Paramesh Copyright © 2017 Morgan S. Martin et al. All rights reserved. Immune Reconstitution Inflammatory Syndrome Occurring in a Kidney Transplant Patient with Extrapulmonary Tuberculosis Tue, 07 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/crit/2017/6290987/ Tuberculosis (TB) occurring in solid organ transplantation (SOT) is associated with significant morbidity and mortality usually due to delays in diagnosis, drug toxicity encountered with antimycobacterial therapy, and drug-drug interactions. TB in SOT patients may mimic other infectious and noninfectious posttransplant complications such as posttransplant lymphoproliferative disorder (PTLD) and systemic cytomegalovirus infection. Immune reconstitution inflammatory syndrome (IRIS) is a host response resulting in paradoxical worsening of an infectious disease which occurs after the employment of effective therapy and reversal of an immunosuppressed state. We describe the development of immune reconstitution inflammatory syndrome (IRIS), a unique complication occurring during the treatment of extrapulmonary tuberculosis occurring after transplant which resulted from decreasing immunosuppression in a patient who received Alemtuzumab induction therapy. Although (IRIS) has been originally described in HIV/AIDS patients receiving highly active antiretroviral therapy (HAART), solid organ transplant recipients with diagnosed or occult TB whose immune system may undergo immune reconstitution during their posttransplant course represent a new high risk group. Jose Iglesias, Kandria Jumil Ledesma, Paul J. Couto, and Jessie Liu Copyright © 2017 Jose Iglesias et al. All rights reserved. Brincidofovir Use after Foscarnet Crystal Nephropathy in a Kidney Transplant Recipient with Multiresistant Cytomegalovirus Infection Mon, 27 Feb 2017 08:26:53 +0000 http://www.hindawi.com/journals/crit/2017/3624146/ Background. Cytomegalovirus (CMV) antiviral drug resistance constitutes an increasing challenge in transplantation. Foscarnet is usually proposed when resistance for ganciclovir is suspected, but its use is limited by its nephrotoxicity. Case Presentation. We report a case of multiresistant CMV disease in a kidney transplant recipient. Foscarnet was prescribed after ganciclovir treatment failure in a patient with two mutations in the UL97 viral gene. Foscarnet induced biopsy-proven kidney crystal precipitation that resulted in severe acute transplant failure and nephrotic syndrome. Despite a large decrease in immunosuppression, CMV disease was not controlled and a salvage therapy with Brincidofovir (BCV), which is an oral lipid conjugate of cidofovir with limited nephrotoxicity, was attempted. Clinical and virological remission was observed after a 21-day course of BCV, despite mild and reversible liver toxicity. However, a new relapse could not be effectively cured by BCV due to a new mutation in the UL54 gene, which is known to confer resistance to cidofovir. A new course of foscarnet finally resulted in prolonged CMV remission. Herein, we present a review of foscarnet nephropathy cases in solid-organ transplanted patients. Conclusions. This unique case highlights the potential benefit of BCV use during resistant CMV infection, although mutations in the UL54 gene may limit its therapeutic efficacy. These findings need to be confirmed in clinical trials. Romain Vial, Christine Zandotti, Sophie Alain, Alexandre Decourt, Noémie Jourde-Chiche, Raj Purgus, Charleric Bornet, Laurent Daniel, Valérie Moal, and Tristan Legris Copyright © 2017 Romain Vial et al. All rights reserved. Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report Tue, 10 Jan 2017 12:49:27 +0000 http://www.hindawi.com/journals/crit/2017/1347052/ Despite the recent development of immunosuppressive agents, plasma cell-rich acute rejection (PCAR) has remained refractory to treatment. Herein, we report an unusual case of PCAR that responded well to pulse steroid therapy alone. A 47-year-old man was admitted for a protocol biopsy three months after kidney transplantation, with a stable serum creatinine level of 1.6 mg/dL. Histological examination showed focal aggressive tubulointerstitial inflammatory cell infiltration of predominantly polyclonal mature plasma cells, leading to our diagnosis of PCAR. Three months following three consecutive days of high-dose methylprednisolone (mPSL) therapy, an allograft biopsy performed for therapy evaluation showed persistent PCAR. We readministered mPSL therapy and successfully resolved the PCAR. Although PCAR generally develops more than six months after transplantation, we diagnosed this case early, at three months after transplantation, with focally infiltrated PCAR. This case demonstrates the importance of early diagnosis and prompt treatment of PCAR to manage the development and severity of allograft rejection. Yo Komatsuzaki, Yasuyuki Nakada, Izumi Yamamoto, Mayuko Kawabe, Takafumi Yamakawa, Ai Katsuma, Haruki Katsumata, Aki Mafune, Akimitsu Kobayashi, Yusuke Koike, Hiroki Yamada, Jun Miki, Yudo Tanno, Ichiro Ohkido, Nobuo Tsuboi, Keitaro Yokoyama, Hiroyasu Yamamoto, and Takashi Yokoo Copyright © 2017 Yo Komatsuzaki et al. All rights reserved. Tacrolimus Toxicity due to Biliary Obstruction in a Combined Kidney and Liver Transplant Recipient Mon, 09 Jan 2017 07:13:05 +0000 http://www.hindawi.com/journals/crit/2017/9096435/ The immunosuppressant tacrolimus has a narrow therapeutic window, necessitating therapeutic drug monitoring to maintain efficacy and minimise toxicity. There are very few reports examining the impact of impaired biliary excretion on tacrolimus blood levels or toxicity. We report the case of a 26-year-old combined liver and kidney transplant recipient, who developed acute biliary obstruction leading to tacrolimus toxicity with very high blood tacrolimus levels. Despite a careful evaluation, no alternative cause was found for her acute kidney injury, and her kidney function returned to previous baseline within several days following treatment of the biliary obstruction and temporary withdrawal of tacrolimus. Samuel Chan, Michael T. Burke, David W. Johnson, Ross S. Francis, and David W. Mudge Copyright © 2017 Samuel Chan et al. All rights reserved. Urinary Obstruction of Transplanted Kidney Caused by Uterine Adenomyosis and 2-Year Posthysterectomy Psoas Abscess in Conjunction with Transplanted Kidney Tue, 20 Dec 2016 15:39:09 +0000 http://www.hindawi.com/journals/crit/2016/7142537/ Urinary obstruction of the transplanted kidney caused by uterine leiomyoma is an extremely rare condition. To the best of our knowledge, there are only two reports in English literature. Psoas abscess secondary to renal graft pyelonephritis is also uncommon. We present this unusual case and its treatment course. A 43-year-old female presented with renal dysfunction. She was started on peritoneal dialysis from the age of 26 years and received kidney transplantation from her mother (living donor) at the age of 27 years. Computed tomography (CT) revealed right hydronephrosis and a large uterine mass compressing the distal ureter of the transplanted kidney. After a simple total hysterectomy, her renal function improved. Two years following the hysterectomy, she experienced painful urination, fever, right abdominal pain, and right lower limb pain. CT and T2-weighed magnetic resonance imaging of her pelvis demonstrated right psoas abscess in conjunction with transplanted kidney. She was treated with broad-spectrum antibiotics alone, which resulted in a good response. Urinary obstruction of the transplanted kidney caused by uterine leiomyoma is an extremely rare condition. Psoas abscess secondary to transplanted kidney pyelonephritis is also rare. We should keep these rare diseases in mind when treating such cases. Yuta Takezawa, Yoshifumi Kadono, Takahiro Nohara, and Atsushi Mizokami Copyright © 2016 Yuta Takezawa et al. All rights reserved. Emergent Management of Intracardiac Thrombosis during Liver Transplantation Wed, 14 Dec 2016 12:44:39 +0000 http://www.hindawi.com/journals/crit/2016/6268370/ Intraoperative thromboembolism is a well-documented complication associated with orthotopic liver transplantation (OLT) but its identification and intraoperative treatment are still an emerging topic in anesthesia. Intracardiac thrombus during OLT is associated with a high mortality rate. There are only a few reports describing the successful management of thromboembolism during OLT. We describe a case where routine intraoperative transesophageal echocardiography during a live donor liver transplantation enabled early detection of an intracardiac thrombus with subsequent successful heparin treatment. Our case suggests that if an intracardiac thrombus is identified early (before hemodynamic instability occurs), the use of IV heparin may be a safe therapeutic option. Caroline Protin, Dmitri Bezinover, Zakiyah Kadry, and Thomas Verbeek Copyright © 2016 Caroline Protin et al. All rights reserved. Scedosporiosis in a Combined Kidney and Liver Transplant Recipient: A Case Report of Possible Transmission from a Near-Drowning Donor Tue, 13 Dec 2016 14:22:01 +0000 http://www.hindawi.com/journals/crit/2016/1879529/ Scedosporium spp. are saprobic fungi that cause serious infections in immunocompromised hosts and in near-drowning victims. Solid organ transplant recipients are at increased risk of scedosporiosis as they require aggressive immunosuppression to prevent allograft rejection. We present a case of disseminated Scedosporium apiospermum infection occurring in the recipient of a combined kidney and liver transplantation whose organs were donated by a near-drowning victim and review the literature of scedosporiosis in solid organ transplantation. Rachael Leek, Erika Aldag, Iram Nadeem, Vikraman Gunabushanam, Ajay Sahajpal, David J. Kramer, and Thomas J. Walsh Copyright © 2016 Rachael Leek et al. All rights reserved. Successful Stem Cell Transplantation in a Patient with Pretransplant Hepatic Inflammatory Pseudotumour Mon, 28 Nov 2016 07:54:03 +0000 http://www.hindawi.com/journals/crit/2016/6801916/ Inflammatory pseudotumours (IPT) are rare benign neoplasms of unknown aetiology. We present a case of hepatic IPT which was incidentally discovered in a patient with relapsed B-acute lymphoblastic leukaemia (B-ALL) undergoing pretransplant workup. After investigation to exclude an infective cause she underwent a reduced intensity conditioning stem cell transplant (SCT) successfully and currently remains well and in remission. On repeat liver MRI after SCT, the IPT was seen to be resolving. To the best of our knowledge this is the first report of an adult patient with hepatic IPT successfully undergoing SCT. The reduction in size of the IPT after SCT also suggests an inflammatory rather than an infective aetiology for IPT. Sanjay de Mel, Zarni Soe, Benjamin Wong, Ching Ching Ong, Lynette Teo, and Lip Kun Tan Copyright © 2016 Sanjay de Mel et al. All rights reserved. ST Elevation Infarction after Heart Transplantation Induced by Coronary Spasms and Mural Thrombus Detected by Optical Coherence Tomography Thu, 17 Nov 2016 09:38:23 +0000 http://www.hindawi.com/journals/crit/2016/1863869/ The case illustrates the possible link between coronary spasms, intraluminal thrombus formation, and widespread organized and layered thrombi in HTx patients. Furthermore, the case underlines the clinical value of OCT as a novel method for high-resolution vessel imaging in heart-transplanted (HTx) patients with coronary spasms and suspected coronary artery disease. Coronary spasms and sudden death are frequent complications after HTx. The underlying mechanisms leading to these complications are unknown. The present case displays the clinical course of a 19-year-old HTx patient who was hospitalized due to acute myocardial infarction induced by severe coronary spasms. The patients remained unstable on conservative therapy. Therefore, an optical coherence tomography (OCT) was performed and revealed massive, organized thrombi in the left main coronary artery, the circumflex coronary artery, and the left anterior descending coronary artery. The patient was stabilized after percutaneous coronary intervention. As a mural thrombus often goes undetected by coronary angiography, OCT may prove benefit in HTx patients with myocardial infarction or suspected coronary spasms. Tor Skibsted Clemmensen, Niels Ramsing Holm, Hans Eiskjær, Steen Hvitfeldt Poulsen, Michael Maeng, Christian Juhl Terkelsen, and Evald Høj Christiansen Copyright © 2016 Tor Skibsted Clemmensen et al. All rights reserved. Massive Ascites in a Renal Transplant Patient after Laparoscopic Fenestration of a Lymphocele Mon, 07 Nov 2016 13:54:38 +0000 http://www.hindawi.com/journals/crit/2016/7491627/ Retroperitoneal lymphocele is a common complication of renal transplantation. Here, we report the case of a 67-year-old woman with massive ascites after fenestration surgery for a lymphocele that developed following renal transplantation. She had been on continuous ambulatory peritoneal dialysis for 9 years. Living donor renal transplantation was performed and an intrapelvic lymphocele subsequently developed. The lymphocele did not resolve after aspiration therapy; therefore, laparoscopic fenestration was performed. Although the lymphocele disappeared, massive ascites appeared in its stead. Half a year later, the ascites was surgically punctured, which then gradually resolved and disappeared 6 weeks later. Aspiration therapy should be considered in patients on long-term peritoneal dialysis, although laparoscopic fenestration is safe and effective. Shohei Kawaguchi, Takahiro Nohara, Takashi Shima, Satoko Matsuyama, Chikako Nose, Junya Yamahana, Yoshifumi Kadono, Chikashi Seto, Masahiko Kawabata, and Atsushi Mizokami Copyright © 2016 Shohei Kawaguchi et al. All rights reserved. Fatal Donor-Derived Carbapenem-Resistant Klebsiella pneumoniae Infection in a Combined Kidney-Pancreas Transplantation Sun, 16 Oct 2016 08:03:32 +0000 http://www.hindawi.com/journals/crit/2016/7920951/ Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant recipients are associated with high morbidity and mortality. We report a case of a fatal donor-derived CR-KP infection in a combined kidney-pancreas transplant. Given the short interval of time between donor hospitalization and organ procurement, information concerning the donor CR-KP positivity arrived only 72 hours after transplant. Based on this experience, we believe that knowledge of the donor’s CR-KP status should be mandatory before procurement and, if positive, pancreas donation should be contraindicated. Giovanni Varotti, Ferdinando Dodi, Anna Marchese, Alessia Terulla, Massimo Bertocchi, and Iris Fontana Copyright © 2016 Giovanni Varotti et al. All rights reserved. Immune Complex Mediated Glomerulonephritis with Acute Thrombotic Microangiopathy following Newly Detected Hepatitis B Virus Infection in a Kidney Transplant Recipient Sun, 09 Oct 2016 14:06:06 +0000 http://www.hindawi.com/journals/crit/2016/3152495/ Hepatitis B virus (HBV) presents a risk to patients and staff in renal units. To minimise viral transmission, there are international and UK guidelines recommending HBV immunisation for patients commencing renal replacement therapy (RRT) and HBV surveillance in kidney transplant recipients. We report the case of a 56-year-old male who was immunised against HBV before starting haemodialysis. He received a deceased donor kidney transplant three years later, at which time there was no evidence of HBV infection. After a further six years he developed an acute kidney injury; allograft biopsy revealed an acute thrombotic microangiopathy (TMA) with glomerulitis, peritubular capillaritis, and C4d staining. Due to a “full house” immunoprofile, tests including virological screening were undertaken, which revealed acute HBV infection. Entecavir treatment resulted in an improvement in viral load and kidney function. HBV genotyping demonstrated a vaccine escape mutant, suggesting “past resolved” infection that reactivated with immunosuppression, though posttransplant acquisition cannot be excluded. This is the first reported case of acute HBV infection associated with immune complex mediated glomerulonephritis and TMA. Furthermore, it highlights the importance of HBV surveillance in kidney transplant recipients, which although addressed by UK guidelines is not currently practiced in all UK units. Tracey Salter, Hannah Burton, Sam Douthwaite, William Newsholme, Catherine Horsfield, and Rachel Hilton Copyright © 2016 Tracey Salter et al. All rights reserved. Strongyloides Hyperinfection Syndrome Combined with Cytomegalovirus Infection Thu, 15 Sep 2016 12:21:30 +0000 http://www.hindawi.com/journals/crit/2016/1786265/ The mortality in Strongyloides hyperinfection syndrome (SHS) is alarmingly high. This is particularly common in bone marrow, renal, and other solid organ transplant (SOT) patients, where figures may reach up to 50–85%. Immunosuppressives, principally corticosteroids, are the primary triggering factor. In general, the clinical features of Strongyloides stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and starting appropriate therapy. Although recurrent Gram-negative sepsis and meningitis have been previously reported, the combination of both cytomegalovirus (CMV) and strongyloidiasis had rarely been associated. We here describe a patient who survived SHS with recurrent Escherichia coli (E. coli) urosepsis and CMV infection. Fatehi Elnour Elzein, Mohammed Alsaeed, Sulafa Ballool, and Ashraf Attia Copyright © 2016 Fatehi Elnour Elzein et al. All rights reserved.