Belatacept and mediastinal histoplasmosis in a kidney transplant patient

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 inf...

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Published inJournal of nephropathology Vol. 5; no. 2; pp. 84 - 87
Main Authors Trimarchi, Hernán, Rengel, Tatiana, Andrews, José, Paulero, Matías, Iotti, Alejandro, Forastiero, Agustina, Lombi, Fernando, Pomeranz, Vanesa, Forrester, Mariano, Iriarte, Romina, Agorio, Iris
Format Journal Article
LanguageEnglish
Published Iran Society of Diabetic Nephropathy Prevention 01.04.2016
Subjects
belatacept
Case Report
histoplasma capsulatum
kidney transplantation
Histoplasma capsulatum
Belatacept
Kidney transplantation
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Summary: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. 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. To our knowledge, this is the first reported case of Histoplasma capsulatum in a kidney transplanted patient on belatacept therapy.
ISSN:2251-8363
2251-8819
DOI:10.15171/jnp.2016.15