Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
Hull-York Medical School, Kingston-upon-Hull, UK.
Transpl Infect Dis. 2021 Feb;23(1):e13454. doi: 10.1111/tid.13454. Epub 2020 Sep 12.
Pneumocystis jirovecii is an opportunistic pathogen that may cause severe, life-threatening respiratory infections in immunocompromised patients such as those with kidney transplants. Although antimicrobial prophylaxis is now universally recommended in the early post-transplant period, Pneumocystis pneumonia (PCP) can occur later. If such infection occurs, mortality rates are high. Beyond standard therapy with trimethoprim-sulfamethoxazole, there is a lack of evidence-based options for intensifying treatment when initial therapy fails to show improvement. Moreover, it is usual to minimize immunosuppression in life-threatening infection, but graft damage may occur, particularly in kidney transplant recipients at above-average immunological risk. Here we present two cases of severe PCP in high immunological risk recipients who were managed with adjunctive intravenous immunoglobulin and withdrawal of immunosuppression. Both patients recovered and were discharged from hospital with functioning grafts.
肺孢子菌是一种机会性病原体，可能会导致免疫功能低下的患者（如肾移植患者）发生严重的、危及生命的呼吸道感染。尽管现在普遍建议在移植后早期进行抗微生物预防，但仍可能会发生肺孢子菌肺炎（PCP）。如果发生这种感染，死亡率很高。除了标准的复方磺胺甲噁唑治疗外，如果初始治疗没有改善，强化治疗缺乏循证选择。此外，在危及生命的感染中通常会尽量减少免疫抑制，但可能会发生移植物损伤，特别是在免疫风险高于平均水平的肾移植受者中。在这里，我们报告了两例高免疫风险受者发生严重 PCP 的病例，他们接受了辅助静脉注射免疫球蛋白和免疫抑制药物撤药治疗。两名患者均康复并出院，移植肾功能正常。
