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논문분류	춘계학술대회 초록집
제목	A CASE REPORT OF EARLY SEVERE PNEUMONIA FOLLOWING LIVING DONOR KIDNEY TRANSPLANTATION
저자	Ratna Damayanti
출판정보	2024; 2024(1):
키워드
초록	Opportunistic infections such as pneumocystis jirovecii, mycobacterium tuberculosis, herpesvirus infection (CMV, HSV, VZV, EBV), HCV, HBV and endemic mycoses are likely to occur 1-6 months after transplantation and often are caused by reactivation of latent infections. Data about opportunistic infection in this population in Indonesia is sparse. We report a case of early severe pneumonia caused by presumptive pneumocystis jirovecii concurrent infection with pulmonary tuberculosis clinically symptoms in a 24-year-old woman, who previously underwent successful living donor kidney transplantation and suffered from Hepatitis C and CMV latent. She did not receive tuberculosis, CMV or pneumocystis jirovecii pneumonia prophylaxis treatment. Six months after kidney transplantation, the patient had low grade fever for seven days followed by nonproductive cough, chest tightness, and shortness of breath 4 days before admitted to hospital. Laboratory results showed increased procalcitonin (2.59 ng/mL), TB sputum test, TB LAM Ag test and IGRA MTB test results were all negative, sputum culture result was staphylococcus epidermidis, decreased absolute lymphocyte count (700/ml), normal CD 4 (39.72%), decreased absolute CD 4 count (278/ml), Ig G anti CMV reactive (572 U/ml), non-reactive Ig M anti CMV (0.245), high CMV Ig G avidity test (72.7%) with negative CMV antigenemia and chest radiographic features show bilateral, symmetrical perihilar interstitial infiltrates with pleural effusion, lymphadenopathy and increased involvement of lung fields and homogeneity overtime suggestive of presumptive pneumocystis jirovecii with tuberculosis infection. Through sulfamethoxazole-trimethoprim (TMP-SMX) treatment combined with micafungin, antibiotics, valacyclovir and anti-tuberculosis treatment, finally, symptoms, such as chest tightness, cough, shortness of breath and desaturation, were improved, renal and liver function were preserved, tacrolimus therapeutic level were maintained and she was discharged by continuing antituberculosis, hepatitis C and immunosuppressive treatment with good clinical symptoms and chest x-ray improvement after discharge.
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