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Nocardial infection in a renal transplant recipient on tacrolimus and mycophenolate mofetil
C C Magee1, R D Halligan, E L Milford
1Laboratory of Immunogenetics and Transplantation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Abstract:
Infection with Nocardia spp. is an uncommon but important cause of morbidity and mortality in organ transplant recipients. Cotrimoxazole prophylaxis against urinary tract infection and Pneumocystis carinii pneumonia in these patients usually prevents nocardial infection also. We report the case of a patient on tacrolimus and mycophenolate mofetil who developed drug-induced diabetes mellitus followed by nocardial brain infection. This infection occurred despite conventional cotrimoxazole prophylaxis. Physicians should be aware that newer, more potent and more diabetogenic immunosuppressive regimens may increase the risk of opportunistic infections such as nocardiosis, even in the presence of "adequate" antimicrobial preventive measures.
Insights
Nocardia brain infections can occur in transplant patients despite cotrimoxazole prophylaxis. Potent immunosuppressants may increase risks of opportunistic infections like nocardiosis.
Area of Science:
- Medical Mycology
- Immunosuppression Therapy
- Transplant Infectious Diseases
Background:
- Nocardia spp. infections are serious complications in organ transplant recipients.
- Standard cotrimoxazole prophylaxis typically prevents Nocardia infections and Pneumocystis pneumonia.
- Organ transplant patients often receive immunosuppressive drugs like tacrolimus and mycophenolate mofetil.
Observation:
- A patient on tacrolimus and mycophenolate mofetil developed drug-induced diabetes mellitus.
- This patient subsequently developed a Nocardia brain infection.
- The infection occurred despite receiving standard cotrimoxazole prophylaxis.
Findings:
- Nocardia brain infection developed in a transplant patient despite cotrimoxazole prophylaxis.
- The patient was on tacrolimus, mycophenolate mofetil, and developed drug-induced diabetes.
- This case highlights a failure of standard prophylaxis in a specific immunosuppressive context.
Implications:
- Newer, potent immunosuppressive regimens may increase the risk of opportunistic Nocardia infections.
- Physicians must consider increased Nocardia risk in patients on diabetogenic immunosuppressants.
- Antimicrobial prophylaxis may need reassessment for transplant recipients on advanced immunosuppressive therapies.