Journal List > J Korean Soc Transplant > v.24(2) > 1034302

Youn, Sang, Hong, Chang, Ji, Yung, In, Dong, Myung, and Moon: Two Cases of Pneumocystis Pneumonia after Liver Transplantation Presenting with Different Clinical Manifestations

Abstract

Pneumocystis carinii pneumonia (PCP), now known as Pneumocystis jirovecii, is a fungal pathogen that causes opportunistic disease, especially pneumonia, in immunocompromised patients. The patients can have a spectrum of illnesses ranging from asymptomatic to fulminant respiratory failure. Here we report two cases with pneumocystis pneumonia after liver transplantation who presented with different clinical features. One patient developed acute respiratory failure requiring mechanical ventilation and expired due to PCP and a superimposed bacterial infection. The other patient was asymptomatic and discovered by regular X-ray check-up. He was successfully treated with trimethoprim/sulfamethoxazole. As shown by our cases, PCP presents with broad clinical manifestations and leads to various clinical courses in liver transplant recipients. Thus, Pneumocystis jirovecii has to be considered a potential pathogen of pneumonia in liver transplant recipients regardless of severity, especially one who is not on prophylactic medications. We consider prophylaxis of PCP in liver transplant recipients in our center.

References

1). Smulian AG, Walzer PD. Pneumocystis infection. Fauci AS, Braunwald E, editors. Harrison's principles of internal medicine. 17th ed.New York: McGraw-hill;2008. p. 1267–9.
2). Snydman DR. Infection in solid organ transplantation. Transpl Infect Dis. 1999; 1:21–8.
crossref
3). Krajicek BJ, Thomas CF Jr, Limper AH. Pneumocystis pneumonia: current concepts in pathogenesis, diagnosis, and treatment. Clin Chest Med. 2009; 30:265–78.
crossref
4). Patel R, Paya CV. Infections in solid organ transplant recipients. Clin Microbiol Rev. 1997; 10:86–124.
5). Trotter JF, Levi M, Steinberg T, Lancaster J. Absence of Pneumocystis jiroveci pneumonia in liver transplantation recipients receiving short-term (3-month) prophylaxis. Transpl Infect Dis. 2008; 10:369–71.
6). Hayes MJ, Torzillo PJ, Sheil AG, McCaughan GW. Pneumocystis carinii pneumonia after liver transplantation in adults. Clin Transplant. 1994; 8:499–503.
7). Spieker C, Barenbrock M, Tepel M, Buchholz B, Rahn KH, Zidek W. Pentamidine inhalation as a prophylaxis against Pneumocystis carinii pneumonia after therapy of acute renal allograft rejection with orthoclone (OKT3). Transplant Proc. 1992; 24:2602–3.
8). Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc. 1996; 71:5–13.
9). Radisic M, Lattes R, Chapman JF, del Carmen Rial M, Guardia O, Seu F, et al. Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study. Transpl Infect Dis. 2003; 5:84–93.
10). Neff RT, Jindal RM, Yoo DY, Hurst FP, Agodoa LY, Abbott KC. Analysis of USRDS: incidence and risk factors for Pneumocystis jiroveci pneumonia. Transplantation. 2009; 88:135–41.
crossref
11). Arend SM, Westendorp RG, Kroon FP, van't Wout JW, Vandenbroucke JP, van Es LA, et al. Rejection treatment and cytomegalovirus infection as risk factors for Pneumocystis carinii pneumonia in renal transplant recipients. Clin Infect Dis. 1996; 22:920–5.
crossref
12). Walzer PD, Smulian AG. Pneumocystis species. Mandell GL, Bennett JE, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 7th ed.Philadelphia: Churchill Livingstone/Elsevier;2010. p. 3377–90.
crossref
13). Colombo JL, Sammut PH, Langnas AN, Shaw BW Jr. The spectrum of Pneumocystis carinii infection after liver transplantation in children. Transplantation. 1992; 54:621–4.
crossref
TOOLS
Similar articles