Department of Medicine, The University of Alabama at Birmingham, AL, USA.
Department of Pathology, The University of Alabama at Birmingham, AL, USA.
J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211014691. doi: 10.1177/23247096211014691.
Solid organ transplant recipients are at risk for a wide range of opportunistic infections, the most common being cytomegalovirus. These infections may occur as reactivation of latent disease, donor-derived, or de novo. In this article, we present a case of acute liver failure secondary to toxoplasmosis following orthotopic liver transplantation. Our patient presented 5 weeks after orthotopic liver transplantation with altered mental status and fatigue. She was found to have disseminated cytomegalovirus infection, which resolved with intravenous ganciclovir; however, she subsequently developed acute liver failure due to toxoplasmosis, which is hypothesized to be donor-derived. Infection with may be asymptomatic in the immunocompetent host; however, in immunocompromised hosts, such as solid organ transplant recipients, this infection can be life threatening. Though prophylaxis with trimethoprim-sulfamethoxazole may prevent infections with , it is often held for renal dysfunction, hyperkalemia, or other side effects, placing patients at risk. With 13 cases now reported, routine screening of donor and recipient for toxoplasma exposure may be warranted.
实体器官移植受者存在广泛的机会性感染风险，最常见的是巨细胞病毒。这些感染可能是潜伏疾病的再激活、供体来源或新发病原体。本文介绍了一例原位肝移植后弓形体病引起的急性肝衰竭。我们的患者在原位肝移植后 5 周出现精神状态改变和疲劳。她被发现患有播散性巨细胞病毒感染，经静脉用更昔洛韦治疗后痊愈；然而，她随后因弓形体病导致急性肝衰竭，据推测该病原体来源于供体。在免疫功能正常的宿主中，感染 可能无症状；然而，在免疫功能低下的宿主中，如实体器官移植受者，这种感染可能危及生命。虽然用复方磺胺甲噁唑预防 感染可能有效，但由于肾功能障碍、高钾血症或其他副作用，常需停药，使患者处于感染风险之中。目前已有 13 例报告，对供体和受体进行弓形体病暴露的常规筛查可能是必要的。
