Disseminated invasive aspergillosis following cytomegalovirus encephalitis in a renal transplant recipient

Cytomegalovirus (CMV) disease is common in renal transplant recipients and predisposes to secondary bacterial and fungal infections. Disseminated invasive aspergillosis is rare in those patients (0.5% of all infections), but has a mortality of almost 90%1. The authors present the case of a 65 year-old cadaveric renal transplant male recipient with a positive CMV IgG serology at the moment of renal transplantation. The initial immunosuppression was cyclosporine A, mycophenolate mofetil and prednisone and the patient was discharged on the 11th post transplant day with a serum creatinine of 3.2 mg/dl. He was readmitted on the 43rd post transplant day with tachypnea and fever, which did not resolve even after large spectrum antibiotherapy. Serious abdominal distension with normal intestinal motility appeared, followed a few days later by an altered level of consciousness. The brain computed tomography (CT) was normal and a chest and abdominal CT revealed generalised distension of the entire digestive tract. Laboratory tests showed CMV antigenemia >1000 cells/ 50 thousands of leucocytes in peripheral blood and CMV genoma was later isolated from cerebrospinal fluid. The patient initiated therapy with ganciclovir and anti-CMV gamaglobulin but, despite a marked reduction in CMV antigenemia, he developed cardiopulmonary arrest. He was then successfully reanimated and put on mechanical ventilation. A few days later a Pseudomonas aeruginosa pneumonia was diagnosed and the patient died from septic shock. The post-mortem anatomopathologic evaluation revealed disseminated invasive aspergillosis (in brain, thyroid, lung and liver) and a bacterial pneumonia. Key-Words: Aspergillosis; cytomegalovirus; kidney transplantation.