Subbiah Arun Kumar, Arava Sudheer, Bagchi Soumita, Madan Karan, Das Chandan J, Agarwal Sanjay Kumar
Arun Kumar Subbiah, Soumita Bagchi, Sanjay Kumar Agarwal, Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029, India.
World J Transplant. 2016 Jun 24;6(2):447-50. doi: 10.5500/wjt.v6.i2.447.
The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation.
肾移植受者肺空洞性病变的鉴别诊断包括感染、恶性肿瘤，较少见的还有炎症性疾病。这些患者需要考虑细菌感染、结核病、诺卡菌病，以及曲霉菌病和隐球菌病等真菌感染。肺隐球菌病通常在移植后16 - 21个月出现，在累积免疫抑制水平较高的患者中更为常见。在此，我们讨论一位有趣的患者，他从未接受过任何诱导/抗排斥治疗，但在移植后保持稳定6年后，既发生了BK病毒肾病，又出现了严重的肺隐球菌感染。该病例凸显了即使在移植多年后看似免疫风险较低的受者中，发生严重机会性感染的风险。
