Belatacept and mediastinal histoplasmosis in a kidney transplant patient
Background:In transplantation immunosuppression enhances the appearance of opportunist infections. An ideal balance between the prevention of rejection, the lowest risk of infections and the highest rates of graft survival is a continuous challenge. Lower doses of immunosuppression may diminish the...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Society of Diabetic Nephropathy Prevention
2016-04-01
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| Series: | Journal of Nephropathology |
| Subjects: | |
| Online Access: | https://nephropathol.com/PDF/JNP-5-84.pdf |
| _version_ | 1797827975903707136 |
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| author | Hernán Trimarchi Tatiana Rengel José Andrews Matías Paulero Alejandro Iotti Agustina Forastiero Fernando Lombi Vanesa Pomeranz Mariano Forrester Romina Iriarte Iris Agorio |
| author_facet | Hernán Trimarchi Tatiana Rengel José Andrews Matías Paulero Alejandro Iotti Agustina Forastiero Fernando Lombi Vanesa Pomeranz Mariano Forrester Romina Iriarte Iris Agorio |
| author_sort | Hernán Trimarchi |
| collection | DOAJ |
| description | Background:In transplantation immunosuppression enhances the appearance of opportunist infections. An ideal balance between the prevention of rejection, the lowest risk of infections and the highest rates of graft survival is a continuous challenge. Lower doses of immunosuppression may diminish the risk of infections, metabolic and hemodynamic complications or even of malignancy, but may expose patients to episodes of acute rejection. New drugs are being developed to improve graft survival at the lowest risk of side effects. Belatacept has recently been introduced in kidney transplantation to inhibit the co-ligand signal of T cell stimulation. It is a drug with a safe profile, is well-tolerated and appears to improve long-term survival of kidney grafts. However, there may be an increase in opportunistic infections which may be facilitated by T cell depression, as Aspergillus sp., Cryptococcus neoformans or tuberculosis. Case Presentation: We describe a 59-year-old female who developed fever, clinical wasting and a mediastinal mass 31 months after receiving a living non-related kidney transplant while on belatacept therapy. A mediastinal node biopsy disclosed the presence of Histoplasma capsulatum. Infection successfully resolved after appropriate antifungal treatment. Conclusions: To our knowledge, this is the first reported case of Histoplasma capsulatum in a kidney transplanted patient on belatacept therapy |
| first_indexed | 2024-04-09T12:57:03Z |
| format | Article |
| id | doaj.art-617133cae66442e9a922c0b7c8a269fe |
| institution | Directory Open Access Journal |
| issn | 2251-8363 2251-8819 |
| language | English |
| last_indexed | 2024-04-09T12:57:03Z |
| publishDate | 2016-04-01 |
| publisher | Society of Diabetic Nephropathy Prevention |
| record_format | Article |
| series | Journal of Nephropathology |
| spelling | doaj.art-617133cae66442e9a922c0b7c8a269fe2023-05-13T11:33:09ZengSociety of Diabetic Nephropathy PreventionJournal of Nephropathology2251-83632251-88192016-04-0152848710.15171/jnp.2016.15JNP_20160410110525Belatacept and mediastinal histoplasmosis in a kidney transplant patientHernán Trimarchi0Tatiana Rengel1José Andrews2Matías Paulero3Alejandro Iotti4Agustina Forastiero5Fernando Lombi6Vanesa Pomeranz7Mariano Forrester8Romina Iriarte9Iris Agorio10Nephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaPathology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaMicrobiology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaNephrology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaMicrobiology Services, Hospital Británico de Buenos Aires, Buenos Aires, ArgentinaBackground:In transplantation immunosuppression enhances the appearance of opportunist infections. An ideal balance between the prevention of rejection, the lowest risk of infections and the highest rates of graft survival is a continuous challenge. Lower doses of immunosuppression may diminish the risk of infections, metabolic and hemodynamic complications or even of malignancy, but may expose patients to episodes of acute rejection. New drugs are being developed to improve graft survival at the lowest risk of side effects. Belatacept has recently been introduced in kidney transplantation to inhibit the co-ligand signal of T cell stimulation. It is a drug with a safe profile, is well-tolerated and appears to improve long-term survival of kidney grafts. However, there may be an increase in opportunistic infections which may be facilitated by T cell depression, as Aspergillus sp., Cryptococcus neoformans or tuberculosis. Case Presentation: We describe a 59-year-old female who developed fever, clinical wasting and a mediastinal mass 31 months after receiving a living non-related kidney transplant while on belatacept therapy. A mediastinal node biopsy disclosed the presence of Histoplasma capsulatum. Infection successfully resolved after appropriate antifungal treatment. Conclusions: To our knowledge, this is the first reported case of Histoplasma capsulatum in a kidney transplanted patient on belatacept therapyhttps://nephropathol.com/PDF/JNP-5-84.pdfbelatacepthistoplasma capsulatumkidney transplantation |
| spellingShingle | Hernán Trimarchi Tatiana Rengel José Andrews Matías Paulero Alejandro Iotti Agustina Forastiero Fernando Lombi Vanesa Pomeranz Mariano Forrester Romina Iriarte Iris Agorio Belatacept and mediastinal histoplasmosis in a kidney transplant patient Journal of Nephropathology belatacept histoplasma capsulatum kidney transplantation |
| title | Belatacept and mediastinal histoplasmosis in a kidney transplant patient |
| title_full | Belatacept and mediastinal histoplasmosis in a kidney transplant patient |
| title_fullStr | Belatacept and mediastinal histoplasmosis in a kidney transplant patient |
| title_full_unstemmed | Belatacept and mediastinal histoplasmosis in a kidney transplant patient |
| title_short | Belatacept and mediastinal histoplasmosis in a kidney transplant patient |
| title_sort | belatacept and mediastinal histoplasmosis in a kidney transplant patient |
| topic | belatacept histoplasma capsulatum kidney transplantation |
| url | https://nephropathol.com/PDF/JNP-5-84.pdf |
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