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Fatal Pneumococcus Sepsis after Treatment of Late Antibody-Mediated Kidney Graft Rejection
Joint Authors
Hanke, Nils
Bräsen, Jan Hinrich
Einecke, Gunilla
Schwarz, Anke
Haller, Hermann
Source
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-6, 6 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-02-28
Country of Publication
Egypt
No. of Pages
6
Main Subjects
Abstract EN
Antibody-mediated rejection (ABMR) is a major cause of late renal allograft dysfunction and graft loss.
Risks and benefits of treatment of late ABMR have not been evaluated in randomized clinical trials.
We report on a 35-year-old patient with deterioration in renal function and progressive proteinuria 15 years after transplantation.
Recurrent infections after a splenectomy following traumatic splenic rupture 3 years earlier had led to reduction of immunosuppression.
Renal transplant biopsy showed glomerular double contours, 40% fibrosis/tubular atrophy, peritubular capillaritis, and positive C4d staining indicating chronic-active ABMR.
ABMR treatment was initiated with steroids, plasmapheresis, and rituximab.
Fourteen days later, she presented to the emergency department with fever, diarrhea, vomiting, and hypotension.
Despite antibiotic treatment she deteriorated with progressive hypotension, capillary leak with pleural effusion, peripheral edema, and progressive respiratory insufficiency.
She died due to septic shock five days after admission.
Blood cultures showed Streptococcus pneumoniae, consistent with a diagnosis of overwhelming postsplenectomy infection syndrome, despite protective pneumococcus vaccination titers.
We assume that the infection was caused by one of the strains not covered by the Pneumovax 23 vaccination.
The increased immunosuppression with B cell depletion may have contributed to the overwhelming course of this infection.
American Psychological Association (APA)
Einecke, Gunilla& Bräsen, Jan Hinrich& Hanke, Nils& Haller, Hermann& Schwarz, Anke. 2018. Fatal Pneumococcus Sepsis after Treatment of Late Antibody-Mediated Kidney Graft Rejection. Case Reports in Nephrology،Vol. 2018, no. 2018, pp.1-6.
https://search.emarefa.net/detail/BIM-1145163
Modern Language Association (MLA)
Einecke, Gunilla…[et al.]. Fatal Pneumococcus Sepsis after Treatment of Late Antibody-Mediated Kidney Graft Rejection. Case Reports in Nephrology No. 2018 (2018), pp.1-6.
https://search.emarefa.net/detail/BIM-1145163
American Medical Association (AMA)
Einecke, Gunilla& Bräsen, Jan Hinrich& Hanke, Nils& Haller, Hermann& Schwarz, Anke. Fatal Pneumococcus Sepsis after Treatment of Late Antibody-Mediated Kidney Graft Rejection. Case Reports in Nephrology. 2018. Vol. 2018, no. 2018, pp.1-6.
https://search.emarefa.net/detail/BIM-1145163
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1145163