Immunosuppressants
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Kaposi sarcoma secondary to Human Herpes virus-8 infection: case report A 44-year-old woman developed Kaposi sarcoma secondary to Human Herpes virus-8 (HHV-8) infection following treatment with antithymocyte globulin, methylprednisolone, tacrolimus, mycophenolate mofetil and prednisone as immunosuppressant therapy and for acute cellular rejection [routes not stated; not all dosages stated]. The woman, who had IgA nephropathy and focal segmental glomerulosclerosis, underwent preemptive living donor kidney transplantation. She received induction immunosuppressant therapy with antithymocyte globulin [rabbit antithymocyte globulin] 6 mg/kg and methylprednisolone. Thereafter, she started receiving maintenance immunosuppressant therapy comprising of tacrolimus (levels 8–10 ng/mL), prednisone and mycophenolate mofetil. One month post-transplant, she was hospitalised with diarrhoea and acute kidney injury. Kidney biopsy revealed Banff borderline acute cellular rejection. Therefore, she started receiving methylprednisolone 450mg with immune globulin, and was discharged. Seven months after the transplant, she developed urinary tract infection due to extended‐spectrum beta‐lactamaseproducing E. Coli. She also experienced dysuria. The woman was treated with ertapenem but, the dysuria persisted. She also experienced flank pain and a sensation of fullness at the site of the transplanted kidney. Subsequent CTscan of the abdomen and pelvis showed non‐specific lymphadenopathy, soft tissue swelling around the transplanted kidney and unilateral thickening of the bladder wall on the side of the allograft. Urine cultures were negative. She was hospitalised. Thereafter, she also developed mild thrombocytopenia and anaemia [aetiology not stated]. She underwent a percutaneous fine needle aspiration and core biopsy of an enlarged retroperitoneal lymph node. Pathology showed spindle cells. A cystoscopy with bladder biopsy was also performed. Tissue from this demonstrated presence of spindle cells. Immunohistochemical stains revealed the presence of HHV‐8 in the tumour nuclei. She was diagnosed with Kaposi sarcoma secondary to HHV-8 infection. Tacrolimus, methylprednisolone and mycophenolate mofetil were discontinued. Prednisone was continued and maintained at a dose of 5mg daily. She was treated with doxorubicin liposomal. After 4 cycles of doxorubicin liposomal, dysuria, flank pain and fullness completely resolved. Eight months later, a follow‐up CT scan of the abdomen and pelvis revealed resolution of the lymphadenopathy and bladder wall thickening. Author comment: "The increased incidence of [Kaposi sarcoma] among [solid organ transplantation] recipients compared to immunocompetent individuals has been attributed to . . . [human Herpes virus-8] infection in endothelial cells associated with immunosuppression." Nair V, et al. An unusual case of Kaposi sarcoma masquerading as cystitis in a kidney transplant recipient. Transplant Infectious Disease 21: No. 5, Oct 2019. 803435189 Available from: URL: http:
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