TY - JOUR
T1 - Eubacterium plautii infection in a kidney transplant recipient
T2 - A noteworthy case of pleural effusion and fever
AU - Orlando, Giuseppe
AU - Pisani, Francesco
AU - Mastrantonio, Paola
AU - Bonanni, Luigi
AU - Di Cocco, Pierpaolo
AU - D'angelo, Maurizio
AU - Tabilio, Antonio
AU - Famulari, Antonio
PY - 2008/7
Y1 - 2008/7
N2 - We report a noteworthy case of Eubacterium plautii infection after kidney transplantation. Our 33-yr-old transplant recipient received standard care; his post-transplant course was uneventful. However, on day 44 he underwent an emergency laparotomy for perforation of the ileum. He was initially treated with ceftazidime, fluconazole and metronidazole, but his fever persisted, so he was switched to meropenem and vancocin. We could not find any cause for his infection. On day 70, his temperature normalized. On day 75, he developed severe leukopenia (280cell/mL). His cytomegalovirus-DNA test result was negative, so all immunosuppressants, except for prednisone, were stopped; instead, antibiotic prophylaxis was started, using caspofungin, trimethoprim-sulfamethoxazole and ciprofloxacin. On day 83, he underwent percutaneous drainage of massive left pleural effusion. We repeatedly cultured the pleural liquid, but it was not till threewk later that we were finally able to identify the causative organism. We hypothesize that the microorganism - which normally resides on the surface of the intestinal lumen - entered the bloodstream via bacterial translocation, eventually colonizing the pleurae. This translocation was favored by our patient poor clinical condition, his immunosuppressive treatment and his heavy antibiotherapy. Our experience highlights the need for wiser use of antibiotics in transplant recipients.
AB - We report a noteworthy case of Eubacterium plautii infection after kidney transplantation. Our 33-yr-old transplant recipient received standard care; his post-transplant course was uneventful. However, on day 44 he underwent an emergency laparotomy for perforation of the ileum. He was initially treated with ceftazidime, fluconazole and metronidazole, but his fever persisted, so he was switched to meropenem and vancocin. We could not find any cause for his infection. On day 70, his temperature normalized. On day 75, he developed severe leukopenia (280cell/mL). His cytomegalovirus-DNA test result was negative, so all immunosuppressants, except for prednisone, were stopped; instead, antibiotic prophylaxis was started, using caspofungin, trimethoprim-sulfamethoxazole and ciprofloxacin. On day 83, he underwent percutaneous drainage of massive left pleural effusion. We repeatedly cultured the pleural liquid, but it was not till threewk later that we were finally able to identify the causative organism. We hypothesize that the microorganism - which normally resides on the surface of the intestinal lumen - entered the bloodstream via bacterial translocation, eventually colonizing the pleurae. This translocation was favored by our patient poor clinical condition, his immunosuppressive treatment and his heavy antibiotherapy. Our experience highlights the need for wiser use of antibiotics in transplant recipients.
KW - Acute rejection
KW - Eubacterium plautii
KW - Fever
KW - Immunosuppression withdrawal
KW - Kidney transplantation
KW - Opportunistic infection
KW - Pleural effusion
UR - http://www.scopus.com/inward/record.url?scp=48249153384&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=48249153384&partnerID=8YFLogxK
U2 - 10.1111/j.1399-0012.2008.00805.x
DO - 10.1111/j.1399-0012.2008.00805.x
M3 - Article
C2 - 18331359
AN - SCOPUS:48249153384
VL - 22
SP - 520
EP - 524
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 4
ER -