Ekmekci Y, Sengul S, Kutlay S, Azap A, Tuzuner A, Erbay B
Ankara University School of Medicine, Department of Nephrology, 06100 Ankara, Turkey.
Transplant Proc. 2005 Jun;37(5):2122-3. doi: 10.1016/j.transproceed.2005.03.020.
We report a case of spontaneous bacterial peritonitis caused by Klebsiella pneumoniae in a 34-year-old male recipient shortly after kidney transplantation. On posttransplant day 10, the patient started complaining of severe abdominal pain and nausea. Body temperature was 38.4 degrees C. The abdomen was diffusely tender with rigidity and rebound. Laboratory data showed a normal erythrocyte sedimentation rate and serum creatinine level but a slightly elevated C-reactive protein concentration and leukocytosis of 36,200 cells/mm(3) with 88% neutrophils. Explorative laparotomy revealed diffuse purulent peritonitis without an intraabdominal source of infection, such as intestinal perforation. The peritoneal fluid revealed greater than 1000/mm(3) white blood cells and many gram-negative bacilli. Fluid cultures yielded growth of Klebsiella pneumoniae. The patient responded to antibiotic therapy; he was discharged in good condition. This case report draws attention to the impaired host defense that may predispose to spontaneous bacterial peritonitis in renal transplant recipients and alerts the clinician to the possibility of this rare disease.
我们报告一例肾移植术后不久的34岁男性受者发生肺炎克雷伯菌引起的自发性细菌性腹膜炎病例。移植后第10天，患者开始诉说严重腹痛和恶心。体温为38.4摄氏度。腹部弥漫性压痛，伴有肌紧张和反跳痛。实验室检查数据显示红细胞沉降率和血清肌酐水平正常，但C反应蛋白浓度略有升高，白细胞计数为36,200个/立方毫米，中性粒细胞占88%。剖腹探查发现弥漫性化脓性腹膜炎，无腹腔内感染源，如肠穿孔。腹腔积液显示白细胞计数大于1000/立方毫米，并有许多革兰氏阴性杆菌。积液培养出肺炎克雷伯菌。患者对抗生素治疗有反应；他康复出院。本病例报告提请注意可能使肾移植受者易患自发性细菌性腹膜炎的宿主防御功能受损，并提醒临床医生注意这种罕见疾病的可能性。
