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Intravenous immunoglobulin as adjunctive therapy in kidney transplant recipients with severe pneumocystis pneumonia
Author(s) -
Edey Matthew M.,
Gunasekera Pumali N.,
Lobb Mark,
Imran Muhammad
Publication year - 2021
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.13454
Subject(s) - medicine , immunosuppression , pneumocystis jirovecii , pneumocystis pneumonia , pneumonia , kidney transplantation , adjunctive treatment , immunology , pneumocystis carinii , trimethoprim , intensive care medicine , kidney , antibiotics , microbiology and biotechnology , biology
Pneumocystis jirovecii is an opportunistic pathogen that may cause severe, life‐threatening respiratory infections in immunocompromised patients such as those with kidney transplants. Although antimicrobial prophylaxis is now universally recommended in the early post‐transplant period, Pneumocystis pneumonia (PCP) can occur later. If such infection occurs, mortality rates are high. Beyond standard therapy with trimethoprim‐sulfamethoxazole, there is a lack of evidence‐based options for intensifying treatment when initial therapy fails to show improvement. Moreover, it is usual to minimize immunosuppression in life‐threatening infection, but graft damage may occur, particularly in kidney transplant recipients at above‐average immunological risk. Here we present two cases of severe PCP in high immunological risk recipients who were managed with adjunctive intravenous immunoglobulin and withdrawal of immunosuppression. Both patients recovered and were discharged from hospital with functioning grafts.