Abstract: TH-PO582
A Case of a Kidney Transplant Recipient with Severe Throat Pain
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Khalifeh-Soltani, Amin, Weill Cornell Medicine, New York, New York, United States
- Kennel, Peter J., Weill Cornell Medicine, New York, New York, United States
- Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States
- Lee, John Richard, The Rogosin Institute, New York, New York, United States
Introduction
Deceased donor renal transplants have a 5-year graft survival rate around 90% at our center. However, combination immunosupressive therapy increases susceptibilty to infections. Here we report the case of a patient with a history of multiple bacterial, viral and fungal infections who presented with throat pain.
Case Description
This 50-year-old woman had chronic kidney disease secondary to lupus nephritis; she received a renal transplant from a deceased donor after a failed transplant from a live donor. She was managed with thymoglobulin-based induction and maintained on mycophenolate mofetil, prednisone, and belatacept, which was switched to tacrolimus four weeks after transplantation. Her course was complicated by ganciclovir-resistant CMV disease of the GI tract, recurrent ESBL E coli bacteremia, RSV bronchiolitis requiring prolonged intubation, Pneumocystic jiroveci pneumonia and probable pulmonary aspergillosis, requiring tracheostomy for ventilator weaning.
Four months after being weaned from the ventilator, she presented with severe right neck pain, throat pain, and dysphagia. MRI revealed a rim enhancing collection in the left laryngeal tissue abutting the left lateral thyroid cartilage. Following percutaneous drainage, cultures grew no bacteria; she was treated with meropenem and vancomycin. Her throat pain and dysphagia worsened and she was started on voriconazole empirically. Left neck exploration revealed a severely remodeled, necrotic and fibrous sternothyroid muscle. Extensive debridement of the deep strap layer was performed and a subperichondrial abscess drained. Pathology revealed necrotic cartilage with septate fungal hyphae, compatible with a diagnosis of Aspergillus laryngeal abscess. Due to progression of the fungal infection on empiric voriconazole, the patient was switched to posaconazole. Her pain and dysphagia improved and she was discharged on day 23 with posaconazole. After 3 months of treatment, her throat pain resolved.
Discussion
We report a rare case of an Aspergillus abscess of the larynx causing neck and throat pain and dysphagia. Differential diagnosis for throat pain in immunosuppressed kidney transplant recipients needs to include bacterial, viral, and fungal pathogens.