Aspergillus infection of a renal allograft without evidence of a site of origin

Abstract

Key words: Aspergillus infection; haemorrhagic infarc-tion; itraconazole; renal allograftIntroductionSpores of Aspergillu arse ubiquitou isn th environe -ment, yet thi s fungus rarely causes invasiv ine diseasea previously normal host In. immunosuppressed trans-plant recipients, however i,t can be a dangerous oppor-tunistic pathogen o, capabl inducinf eg fulminantclinical disease I.t has a propensity for invading bloodvessels, both smal anld large an, d both arterie andsveins, causing thrombosi ansd infarctio [1]n . I renan ltransplantation, Aspergillus infection usually affectsprimarily the lungs—with occasional dissemination—and the CNS [2] Infectio. n of a single organ withoutan overt site of origin has been rarely reported. IsolatedAspergillus infectio ofn th kidnee hay bees n mainlyreported in patients with malignancie osr diabetes, andin intravenous dru [3]g user. Th renase l lesion arescharacterized pathologicall by multiply e parenchymalmicroabscesses, indicativ oef haematogenous spread tothe organ. We report a case of early isolated Aspergillusinfection of the allograf t without evidenc of a sitee oforigin in a renal transplant patient.Case reportA 63-year-ol mad n wa admittes d to th hospitae l witha histor oyf feve anr d progressive dispneoea 20 day, safter a cadaveric renal transplantation fro a 24-yearm -old donor Th. donore a, cas oef cranioencephali ctrauma, had died 72 h after admissio ton the intensivecare unit withou ant y evidence of an infectious process.The initial immunosuppressio ha consisted ofdnquadruple therapy including prednisone, azathioprine,induction with tymoglobuline an delayed us,de ofcyclosporine. The postoperative course was uncomplic-