Smolovic Brigita, Vukcevic Batric, Muhovic Damir, Ratkovic Marina
Faculty of Medicine, University of Montenegro, Podgorica 20000, Montenegro.
Department of Gastroenterohepatology, Clinical Center of Montenegro, Podgorica 20000, Montenegro.
World J Clin Cases. 2018 Dec 26;6(16):1155-1159. doi: 10.12998/wjcc.v6.i16.1155.
Aspergillosis is a frequent invasive fungal infection in liver recipients (affecting 1%-9.2% of all patients), second only to candidiasis. Significant risk factors for invasive aspergillosis in liver recipients include corticosteroid therapy, neutropenia, T-cell dysfunction, renal failure and requirement for renal replacement therapy. Aspergillus infection usually affects the lungs of liver recipients, with hematogenous dissemination occurring in 50%-60% of cases. Renal involvement is rare and is considered to occur in 0.4% of all cases of invasive aspergillosis.
This paper describes a case of a liver recipient presenting with a newly formed renal mass a year after liver transplantation. The patient underwent liver transplantation due to alcoholic liver cirrhosis, with preoperative corticosteroid therapy and postoperative immunosuppressants (tacrolimus and mycophenolate mofetil). His 1-year follow-up was uneventful, with a satisfying graft function and lack of any symptoms. During a routine follow-up abdominal ultrasound, he was diagnosed with a renal tumor. The renal imaging findings were inconclusive (with a differential diagnosis to renal cell carcinoma), while the computed tomography (CT) of the chest showed scar tissue in the lungs suggestive of previous inflammation. The patient underwent radical nephrectomy, with histopathological analysis showing renal aspergilloma, yielding postoperative treatment with voriconazole. His follow up was uneventful, and the chest CT did not show any change in pulmonary lesions. This case illustrates the possibility of aspergillosis affecting the lungs of liver recipients, subsequently affecting the kidney and forming an aspergilloma.
Clinicians should be aware of aspergilloma mimicking solid organ tumors in organ recipients.
曲霉病是肝移植受者中常见的侵袭性真菌感染（占所有患者的1%-9.2%），仅次于念珠菌病。肝移植受者发生侵袭性曲霉病的重要危险因素包括皮质类固醇治疗、中性粒细胞减少、T细胞功能障碍、肾衰竭以及肾脏替代治疗需求。曲霉感染通常影响肝移植受者的肺部，50%-60%的病例会发生血行播散。肾脏受累罕见，在所有侵袭性曲霉病病例中占0.4%。
本文描述了一例肝移植受者在肝移植术后一年出现新发肾脏肿物的病例。该患者因酒精性肝硬化接受肝移植，术前接受皮质类固醇治疗，术后使用免疫抑制剂（他克莫司和霉酚酸酯）。其1年随访情况良好，移植肝功能满意且无任何症状。在一次常规随访腹部超声检查中，他被诊断为肾肿瘤。肾脏影像学检查结果不明确（鉴别诊断为肾细胞癌），而胸部计算机断层扫描（CT）显示肺部有瘢痕组织，提示既往有炎症。患者接受了根治性肾切除术，组织病理学分析显示为肾曲菌球，术后接受伏立康唑治疗。其随访情况良好，胸部CT显示肺部病变无任何变化。该病例说明了曲霉病可能影响肝移植受者的肺部，随后累及肾脏并形成曲菌球。
临床医生应意识到曲菌球在器官移植受者中可模仿实体器官肿瘤。
