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TID Chat Clinico-Pathologic Conference (CPC)
The TID Chat CPCs are a collaboration between the Transplant Infectious Diseases Section of TTS (https://tts.org/tid-about/tid-presidents-message) and the Transplant Infectious Disease Journal. Cases, selected from those submitted to the Journal, are presented as a live webinar where diagnosis and management are discussed with experts in the field. This is then written into a summary of the case published here. The video recording of the webinar is available with each of the published CPCs.
Into the unknown: Diagnosing mysterious brain lesions
In this inaugural clinicopathological conference, the invited experts discussed the diagnostic approach to central nervous system infections in immunocompromised hosts. The case presented involved a pancreas-kidney transplant recipient with multiple brain abscesses caused by Bartonella henselae. CSF metagenomic next-generation sequencing played a significant role in the diagnosis. Bartonella henselae is a gram-negative zoonotic pathogen that causes cat-scratch disease, which can be transmitted to humans through cat bites or scratches. Symptoms can vary in severity, correlating with the patient's immune status. Visceral organ involvement, ocular involvement, and neurological manifestations have been reported in immunocompromised patients, but brain abscesses are rare.
Cutaneous lesions in a solid organ transplant recipient: A diagnostic dilemma
We present the case of a 66-year-old female with a history of renal transplant in 1999 with new onset fevers and diffuse skin ulcerations. In this article, we present the diagnostic studies, differential diagnosis, and treatment decisions for the case.
Lung abscess and empyema in a heart transplant recipient from Thailand
The case discussed involves a 69-year-old Thai woman who underwent orthotopic heart transplantation 9 months before this event. She presented with fever without localizing signs or symptoms. However, her chest images revealed mass-like consolidation in the left upper lobe. Blood culture and lung tissue identified Rhodococcus equi. She was successfully treated with a combination of antimicrobial therapy, optimization of immunosuppressants, and surgical resection.
Complex considerations – Fever and pancytopenia after solid organ transplantation
This case describes a 42-year-old man who underwent kidney transplantation and developed fevers, pancytopenia, and elevated liver function tests starting on post-operative day 9. An extensive microbiologic and molecular workup was performed, ultimately leading to a diagnosis of donor-derived toxoplasmosis with associated hemophagocytic lymphohistiocytosis in the recipient. This case highlights the potential for post-transplant toxoplasmosis in high-risk mismatch (D+/R-) recipients, as well as the role of Toxoplasma-targeted prophylaxis in such patients.
Aspergillus spp. renal arteritis after kidney transplantation: A reappraisal
Aspergillus spp. is an uncommon and life-threatening cause of transplantrenal artery pseudoaneurysm after kidney transplantation.
We report the case of a 62-year-old woman who underwent kidney transplantation 10 months before and presented a 7-cm asymptomatic transplant renal artery pseudoaneurysm. Transplanted kidney and pseudoaneurysm were surgically removed in emergency. Renal graft, urine, and pseudoaneurysm cultures grew Aspergillus flavus. She recovered after 12 months of antifungal therapy.
To date 14 cases of Aspergillus spp. renal arteritis after kidney transplantation have been published, including 50% Aspergillus flavus arteritis. Vast majority were diagnosed within 90 days after transplantation (73%). Despite allograft nephrectomy and antifungal therapy, mortality rate was high (33%).
Successful treatment of Rhodococcus lung abscess and empyema thoracis in a heart transplant recipient
Rhodococcosis is an uncommon cause of pulmonary infection in thoracic organ transplant recipients. We describe a heart transplant recipient diagnosed with Rhodococcus equi left upper lung abscess with empyema thoracis complicated by bacteremia. The patient was successfully treated with appropriate antibiotics, adequate surgical resection, and optimization of immunosuppressants.