Immunosuppressants
- PDF / 175,760 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 28 Downloads / 138 Views
1 S
Parvovirus B19 Infection: Case Report: case report A 33-year-old man developed parvovirus B19 infection during immunosuppressive therapy with basiliximab, everolimus, methylprednisolone, prednisone and tacrolimus [not all routes and dosages stated]. The man had a history of chronic kidney disease from an unknown cause. He underwent a renal biopsy on 2012 with an uncertain diagnosis of nephronophthisis and commenced on haemodialysis in April 2017. He also had a history of hypertension, ectatic ascending aorta and secondary hyperparathyroidism. He had undergone an appendectomy. In January 2018, he received an allogeneic kidney transplant from a deceased donor. He received induction immunosuppressive therapy with basiliximab and IV methylprednisolone 500mg, followed by maintenance therapy with tacrolimus 0.12 mg/kg/day (target: 8–10 ng/mL during the first month and 5–6 ng/mL thereafter), everolimus 1.25mg twice a day (target, 6–8 ng/mL during the first month and 3–5 ng/mL thereafter) and prednisone 20 mg/day. For the first 6 months after his transplantation, he received a primary prophylaxis against Pneumocystis jirovecii-related pneumonia with pentamidine. After transplantation, he had a delayed graft function of 1 day, for which haemodialysis was performed. He then achieved a good renal function, with a creatinine level of 1.52 mg/dL at discharge. By the follow-up, he had reached an even better graft function, with stable creatinine values ranging from 1.1 mg/dL to 1.3 mg/dL. In April 2019, he was admitted with a 2-week history of fever, sore throat and progressive anaemia with no signs of active bleeding except for occasional episodes of epistaxis. His physical examination was unremarkable; there was no rash, there was a normal vesicular murmur, and his tonsils were slightly erythematous. On admission, his body temperature was normal and he was eupneic with a BP of 114/75mm Hg. Laboratory findings revealed the following: WBC 4490 mm3, platelet 2 26 000 mm3, haemoglobin 7.9 g/dL, serum creatinine 1.28 mg/dL, CRP 0.3 ng/mL, blood urea nitrogen 20 mg/dL, procalcitonin 0.05 ng/mL, no electrolyte abnormalities and urine protein to creatinine ratio 0.37. Several other investigations were unremarkable. His chest radiograph was negative for focal lesions suggestive of infection. The urinary culture results, blood culture results, antibody/antigen human immunodeficiency virus (HIV) test, nasopharyngeal swab, QuantiFERON TB-Gold test, cytomegalovirus DNAemia on plasma test, mannan antigen test, galactomannan antigen test and cryptococcal antigen test were all negative. The neoplastic markers, the complement study, and the immunologic study were also negative. Epstein Barr virus (EBV) DNA seropositivity was found [aetiology not stated]. The anemia was treated with blood transfusion (4 transfusions in total during hospitalisation). Because of the fever of unknown origin with doubtful signs of infection, no antibiotic therapy was started during the first few days. After a laboratory result of positive mycoplasma IgM antibo
Data Loading...
