Late Onset Infection of Pneumocystis jirovecii Infection in a Renal Transplant Recipient

Dong Han Kim; Hee Yeoun Kim; Jeong Hee Yun; Doo Youp Kim; Hyun Do Jung; Jin Ho Lee; Joon Seok Oh; Seong Min Kim; Young Hun Sin; Joong Kyung Kim

doi:10.4285/jkstn.2015.29.4.242

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Kim, Kim, Yun, Kim, Jung, Lee, Oh, Kim, Sin, and Kim: Late Onset Infection of Pneumocystis jirovecii Infection in a Renal Transplant Recipient

Case Report

J Korean Soc Transplant 2015;29(4):242-246.

Published online: 10 December 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.4.242

Late Onset Infection of Pneumocystis jirovecii Infection in a Renal Transplant Recipient

Dong Han Kim, M.D., Hee Yeoun Kim, M.D., Jeong Hee Yun, M.D., Doo Youp Kim, M.D., Hyun Do Jung, M.D., Jin Ho Lee, M.D., Joon Seok Oh, M.D., Seong Min Kim, M.D., Young Hun Sin, M.D., Joong Kyung Kim, M.D.

Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea

Corresponding author: Joong Kyung Kim, Department of Internal Medicine, Bong Seng Memorial Hospital, 401 Jungang-daero, Dong-gu, Busan 48775, Korea Tel: 82-51-664-4880, Fax: 82-51-664-4229 E-mail: kidney119@hotmail.com

Received 17 August 2015 Revised 22 December 2015 Accepted 23 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.

Keywords: Kidney transplantation, Pneumonia, Pneumocystis jirovecii, infection

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Fig. 1.

(A) On admission day, chest posteroanterior (PA) shows diffusely increased density in both lower lung zone. (B) After 3 weeks, diffuse opacities is not seen in chest PA.

Fig. 2.

(A) High resolution computed tomography (HRCT) on admission shows diffuse ground glass opacity (GGO) of lower lung predominance. (B) After 8 days, HRCT shows more aggravated lesions. (C) HRCT on day 21 shows a dramatic regression of the GGO after treatment.

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