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Infective endocarditis in the setting of renal transplantation: Case report and review of the literature
Author(s) -
Nardi Agmon Inbar,
Goldberg Elad,
Cohen Eytan,
Krause Ilan
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12786
Subject(s) - medicine , infective endocarditis , transplantation , bacteremia , endocarditis , surgery , hemodialysis , population , fever of unknown origin , antibiotics , environmental health , microbiology and biotechnology , biology
Abstract The potent immunosuppressive drugs used by transplant recipients place them at risk of infections. Data on infective endocarditis ( IE ) in the setting of renal transplantation ( RT ) are sparse. We describe a 36‐year‐old woman referred to a tertiary medical center for evaluation of elevated creatinine levels 1 month after a second RT . Work‐up revealed the presence of all four of Duke's criteria: fever, persistent bacteremia, new‐onset tricuspid regurgitation, and masses suspected to be vegetation attached to the tricuspid annulus. Symptoms resolved with antibiotic treatment and fluids. Fluorodeoxyglucose‐positron emission tomography/computed tomography ( FDG ‐ PET / CT ) revealed hypermetabolic absorption in the femoral vascular graft that had been used for hemodialysis prior to transplantation. The graft was removed by open surgery, and the patient was discharged home in good condition with continued antibiotic treatment. Review of the literature yielded 73 previously reported cases of IE in renal transplant recipients. Several differences were noted from IE in the general population: lower male predominance, younger age (<60 years), absence in most cases of a preexisting structural cardiac anomaly, and more variable causative pathogens. Our case also highlights the importance of FDG ‐ PET / CT for detecting the source of IE and alerts clinicians to the sometimes unexpected course of the disease in renal transplant recipients.