A case of fever of unknown origin with severe stomatitis in renal transplant recipient resulting in graft loss

Clinical Transplantation
R KatafuchiS Fujimi

Abstract

We present a case of fever of unknown origin and life-threatening stomatitis developed about 60 months after renal transplantation. He was 15 yr old at the transplantation. Bacterial, fungal, and viral infections were not evident. Fever and stomatitis were resistant to acyclovir and to any anti-bacterial or anti-fungal treatment. Graft biopsy revealed a small focus of acute vascular rejection, but the findings were not severe enough to be an etiology of the fever in this case. The administration of cyclosporine (CYA) was stopped 19 d before graftectomy, but the clinical picture was unchanged. Fever and stomatitis was resolved immediately after graftectomy and the discontinuation of immunosuppressants such as mizoribine (MZ) and prednisolone. Pathological changes of the graft included chronic transplant glomerulopathy, acute glomerulitis, and lymphocyte infiltration in peritubular capillaries. Thus we suppose that immunosuppressants were the cause of both fever and stomatitis in this case. We speculate that a fever in this case might be due to the immunosuppressant itself, i.e., CYA or MZ, or viral infection probably herpes-simplex virus infection. It is probably the immunosuppressive state per se that may cause the resistance o...Continue Reading

References

Feb 1, 1979·Journal of Oral Pathology·W R TyldesleyR A Sells
Oct 1, 1976·Infection and Immunity·J A ArmstrongM Ho
Jun 1, 1990·Tubercle·A M Mansour
Feb 1, 1985·Antimicrobial Agents and Chemotherapy·H Osada, K Isono
Jan 1, 1996·Nephron·M A el-ShahawyS G Massry
Feb 13, 1999·Kidney International·L C RacusenY Yamaguchi

Citations

Oct 25, 2006·Transplantation·Martin L MaiThomas Gonwa
May 3, 2011·Journal of Bioscience and Bioengineering·Takahisa HiramitsuKazuharu Uchida
Dec 7, 2007·Infectious Disease Clinics of North America·Emilio BouzaPatricia Muñoz

Related Concepts

Fever of Unknown Origin
Graft Rejection
Immunosuppressive Agents
Oral Mucositis
Kidney Transplantation

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