J Korean Soc Transplant.  2009 Sep;23(2):161-165. 10.4285/jkstn.2009.23.2.161.

Pneumonia Caused by Fungus, Pneumocystis Jirovecii and Cytomegalovirus Coinfection in Patient with Renal Transplantation: A Case Report

• Kim TY
• Nam WJ
• Kim SM
• Shin JH
• Lee KE
• Kim SH
• Oh DJ
• Yu SH

• KMID: 2097084
• DOI: http://doi.org/10.4285/jkstn.2009.23.2.161

Abstract

Renal transplantation has become a well-established, definitive, highly successful therapy for end stage renal disease and been increased in previous decades. Korean Network for Organ Sharing reports that renal transplantation has been performed over 800 cases per year during five years. Although graft survival after renal transplantation has increased with the development of numerous new immunosupressive agents, infectious complications remain a significant cause of morbidity and mortality in renal transplant recipients.Cytomegalovirus (CMV) is a major virus in organ transplant recipients and is associated with opportunistic superinfection with a range of different microorganisms including Pneumocystis jirovecii, fungi, gram negative bacterias. In this paper, we report a case of pneumonia caused by fungus, Pneumocystis jirovecii, CMV in patient with renal transplantation. Based on the strong suspicion of superinfection, we aggressively diagnosed by performing surgical method and successfully treated the condition. Patients with CMV pneumonitis may be predisposed to superinfection by other pathogen and is associated with high mortality. Therefore, if superinfection is suspected, prompt diagnosis involving invasive methods and early initiation of antiviral, antifungal therapy are essential to reduce the mortality.

Keyword

Kidney transplantation; Pneumonia; Cytomegalovirus infections

MeSH Terms

Coinfection
Cytomegalovirus
Cytomegalovirus Infections
Fungi
Graft Survival
Gram-Negative Bacteria
Humans
Kidney Failure, Chronic
Kidney Transplantation
Pneumocystis
Pneumocystis jirovecii
Pneumonia
Superinfection
Transplants
Viruses

Figure

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  Fig. 1. (A) Chest radiograph shows peribronchial infiltration in both lung fields especially left. (B) Chest radiograph obtained 13 days later shows decreased bilateral infiltration.

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  Fig. 2. (A) HRCT section through the lung bases shows multiple consoliations and diffuse ground glass opacification in both lower lungs. (B) HRCT obtained 13 days later shows interval improvement with diffuse gound glass opacification and cosolidations in both lungs.

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  Fig. 3. (A) Hematoxylin eosin staining (×400) showing the infla-mmatory cell infiltration in the in-terstitium and exudation in alveo-lar space. (B) Immunohistochemi-cal staining for CMV (×400) showing positive, round cells (C) Gomori methenamine silver staining (×400) showing the wall of pneumocystis cyst. (D) Periodic acid-schiff stain-ing (PAS, ×400) showing myecelia, spore that are suggestive of fungi.

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  Fig. 4. Clinical course and serial management. (Trimethoprim- Sulfamethoxazole for 111 days, Amphotericin B for 40 days, Ganciclovir for 39 days, Cefepime for 20 days, Vancomycin for 17 days, imipenem for 9 days).

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