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Kidney Week

Abstract: PO2219

A Very Rare Presentation of Oral Invasive Aspergillosis Immediately Post Kidney Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Dabbas, Walaa Said, University of Illinois at Chicago, Chicago, Illinois, United States
  • Hajjiri, Zahraa F., University of Illinois at Chicago, Chicago, Illinois, United States
  • Kumar, Prerna, University of Illinois at Chicago, Chicago, Illinois, United States
  • Ansari, Sajid Q., University of Illinois at Chicago, Chicago, Illinois, United States
  • Naik, Ruchi Harshadrai, University of Illinois at Chicago, Chicago, Illinois, United States
Introduction

Although oral candida infection is very common opportunistic infection after kidney transplant, there are incidences of other fungal infections like aspergillosis, cryptococcosis, histoplasmosis, coccidioidomycosis, Blastomyces dermatiti etc. that are also important to be considered. Here we are reporting a very rare presentation of oral aspergillosis in very early phase post Kidney transplant.

Case Description

38 years old Hispanic female with history of systemic lupus erythematosus and lupus nephritis since 2005, last lupus flare in June 2020 was treated with rituximab and high dose prednisone followed by maintenance with azathioprine and hydroxychloroquine. She received preemptive directed deceased donor kidney transplant in November 2020 with thymoglobulin induction followed by Tacrolimus and Mycophenolate mofetil maintenance therapy. 1 month post-transplant she received pulse dose intravenous Methylprednisone for acute T cell mediated rejection and prednisone was added to her maintenance immunosuppressive regimen. 2 months later she presented with a necrotic lesion with pain over the hard palate with a couple of more oral lesions with similar characteristics. she underwent debridement with excision and biopsy that confirmed oral aspergillosis. She was treated with isavuconazole for 3 months. The oral lesions eventually recovered after 12 weeks of treatment.

Discussion

Oral aspergillosis is very rare but associated with high morbidity and mortality if not treated timely. The diagnosis is based on tissue culture and histopathologic findings. The treatment is surgical combined with systemic fungal therapy for at least 3-6 months. Our patient developed the infection early post kidney transplant due to her recent extensive immunosuppression before and after kidney transplant.