Strongyloides Superinfection After Liver Transplantion
- PDF / 1,143,245 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 13 Downloads / 168 Views
STANFORD MULTIDISCIPLINARY SEMINARS
Strongyloides Superinfection After Liver Transplantion Andrew Ofosu1 · John Higgins2 · Joseph S. Frye2 · Radhika Kumari1 · Monique T. Barakat1,3,4 Accepted: 23 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords ERCP · Strongyloides · Immunocompromise · Orthotopic liver transplantation
Case Presentation and Evolution A 61-year-old man was evaluated for 6 weeks of progressive early satiety, bloating, weight loss, and fatigue. His vital signs were notable for a weight of 60 kg (down from 65 kg 6 weeks prior) and height of 1.65 m, for a body mass index of 22.01 kg/m2. Laboratory studies were notable for early neutrophilic leukocytosis (white blood cell count of 16,500/ µL, 41% neutrophils), as well as hyponatremia (serum sodium 119 mmol/L) and elevated of alkaline phosphatase (187 IU/L). Physical examination revealed a chronically illappearing man with healed abdominal incisions consistent with his past surgical history, and mild mid-epigastric and right upper quadrant tenderness. His past medical history was most notable for orthotopic liver transplantation 7 months previously for alcoholic cirrhosis, and concurrent immunosuppression with oral prednisone 2.5 mg daily, mycophenolate, and tacrolimus. His pre-transplant course was remarkable for latent tuberculosis (QuantiFERON-TB-Gold test positive, negative stain and culture for acid fast bacilli in sputum, and negative chest X-ray) treated with ongoing isoniazid and vitamin B6, and latent syphilis of unknown duration treated with a multidose penicillin G benzathine protocol in the peri-transplant
* Monique T. Barakat [email protected] 1
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA
2
Department of Pathology, Stanford University Medical Center, Stanford, CA 94305, USA
3
Division of Pediatric Gastroenterology and Hepatology, Lucille Packard Children’s Hospital, Stanford University Medical Center, Stanford, CA 94305, USA
4
Divisions of Adult and Pediatric Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Mail Code #5244, Stanford, CA 94304, USA
period. His post-transplant course was complicated by right pleural effusion and hydrothorax, managed with pigtail drain placement, followed by drain removal during the month following liver transplant with an extended criteria (deceased donor) allograft. Within the first month post-transplant, he developed non-anastomotic biliary tree abnormalities leading to biliary cast syndrome and recurrent cholangitis, for which he underwent serial endoscopic retrograde cholangiopancreatography (ERCP) procedures with intra-biliary irrigation, biliary cast and debris extraction and plastic biliary stent exchange. Percutaneous liver biopsies were obtained in order to evaluate his persistent elevation of liver function tests and had demonstrated changes that ranged from large bile duct obstruction and acute or chronic rejection. The patient’s
Data Loading...
