K.T. Leung

Treatment of vancomycin-intermediate Staphylcoccus aureus endocarditis with linezolid.

We report a case of infective endocarditis due to vancomycin-intermediate Staphylococcus aureus that developed after repeated courses of vancomycin. The patient had underlying end stage renal disease and dissecting aortic aneurysm with aortic graft and prosthetic aortic valve replacement. He responded to prolonged combination therapy with linezolid and amikacin without undergoing surgical intervention.

Ultrasonography in the management of exit site infections in peritoneal dialysis patients

Aim:  To assess the efficacy of using ultrasonography (USG) in monitoring the progress of exit site infection (ESI) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Fatal case of Aspergillus coinfection in a renal transplant recipient suffering from cytomegalovirus pneumonitis (Case Report)

SUMMARY:  Cytomegalovirus (CMV) disease is common in postrenal transplant recipients, and may predispose the patients to secondary bacterial or fungal infections. However, simultaneous coinfection is rare and often makes diagnosis difficult. We report a case of CMV pneumonitis in a renal transplant recipient presenting with elevated CMV pp65 antigen level and abnormal chest radiograph. Despite potent and broad‐spectrum antimicrobial therapy, his condition deteriorated rapidly – he soon went into respiratory failure, septic shock and died several days later. Transbronchial biopsy and bronchoalveolar lavage obtained before the patients death showed evidence of invasive pulmonary aspergillosis with concomitant CMV pneumonitis. High index of suspicion and early and empirical initiation of antifungal therapy may be necessary for successful management of fulminant pneumonia in solid organ transplant recipients.

An unusual case of both upper and lower gastrointestinal bleeding in a kidney transplant recipient.

Background. Tuberculosis (TB) is an uncommon opportunistic infection in immunocompromised patients. Extrapulmonary infection involving the intestine is rare and poses diagnostic difficulties.

Successful kidney re-transplantation in a patient with previous allograft kidney tuberculosis.

Abstract: Opportunistic infections, and in particular tuberculosis (TB), carry substantial morbidity and mortality in solid organ transplant recipients. We report a 39‐year‐old man who underwent a cadaveric renal transplant. Three months postoperatively, he was diagnosed to have tuberculous infection of his graft kidney manifested as fever and renal impairment. The diagnosis was confirmed by renal biopsy, which showed granuloma formation and positive stain for acid‐fast bacilli (AFB). His systemic symptoms responded well to a complete course of anti‐tuberculous therapy, but his renal function continued to deteriorate. Graft nephrectomy was performed and the patient underwent a second kidney transplant 1 year later. He remained well and asymptomatic thereafter. No signs of recurrence of tuberculous infection were noted up until the present time. This case illustrates that TB remains an important threat to transplant recipients. Although reactivation of dormant TB is the usual mode of infection, acquisition from the donor graft is also possible. The latter may account for the infection in our case, as our patient had a negative tuberculin skin test and normal chest radiograph prior to transplant. The identification of AFB in the kidney graft less than 3 months postoperatively also suggested that causal relationship. While diagnosing TB in post‐transplant recipients is difficult and may require renal biopsy, as in our case, treatment on the other hand is no different from the standard protocols. However, no consensus has been reached on the safety of re‐transplantation. Also, the need for graft nephrectomy and chemoprophylaxis remains unclear.