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Kidney Week

Abstract: PO2220

Simultaneous Occurrence of Actinomyces Gastritis and Severe Rejection in a Kidney Pancreas Transplant Recipient

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Thimmisetty, Ravi K., Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Soltani, Zohreh Sarah, Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Staffeld-Coit, Catherine G., Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
  • Garces, Jorge C., Ochsner Medical Center - New Orleans, New Orleans, Louisiana, United States
Introduction

We are presenting a 33 year old lady with history of Kidney Pancreas transplant admitted for rejection treatment and found to have co infection, actinomyces and CMV in gastric mucosa. Patient was managed well with modified net immunosuppression and discharged safely on long term antibiotics.

Case Description

33 year old woman with h/o stage V CKD from type I diabetes mellitus had Simultaneous kidney pancreas transplant in 2018 admitted directly from clinic for rejection treatment. admission vitals were temperature 97 f, blood pressures of 151/99, heart rate 83, respiratory rate 18 , on room air. exam unremarkable. home Immunosuppression is cyclosporine, sirolimus and prednisone. baseline creatinine is 1.1-1.3 mg/dl. Admission creatinine is 5.0, BUN 33, lipase 290, amylase 124, cyclosporine level is 52, sirolimus level < 2, immuknow cylex 332, HbA1C is 5.3, c peptide is 3.13. renal biopsy showed acute cellular rejection, moderate microvascular inflammation, C4d positive, acute antibody mediated rejection. Class I and II DSA were positive. she got 3 doses of solumedrol, 3 doses of thymoglobulin, 2 sessions of plasmapheresis. She was found to have group B streptococcal bacteremia. Removed central line. CT scan of abdomen and pelvis was done for chronic abdominal pain showed diffuse gastritis or infiltrative disease such as gastric lymphoma. EGD showed gastric ulcer with Actiomyces colonization. Biopsy of gastric mucosa showed reactive gastropathy, purulent exudate, ample Actinomyces colonies, No lymphoma or cancer. CMV viral inclusions also seen. Serum CMV PCR negative. Further rejection treatment was placed on hold. Scheduled 2 doses of IV IG outpatient and resume mycophenolate mofetil as an outpatient after finishing antibiotics. Discharged with cyclosporine, prednisone, long term IV ampicillin, valcyte and follow up EGD in 4 weeks. Outpatient renal transplant biopsy was scheduled after completion of antibiotics to assess rejection. creatinine was plateud around 3.4. lipase and amylase were normalized.

Discussion

Actinomycosis is considered an endogenous, opportunistic infection of immunocompromised patients. Incidence is about one per 500 000 (0.0002%) in developed countries. Prevalence of actinomycosis was around 0.02% in transplant recipients. Infections alter the management and outcome of graft rejections.