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Intestinal microsporidiosis occurring in two renal transplant recipients treated with mycophenolate mofetil
A Guerard1, M Rabodonirina, L Cotte
1Service de Transplantation Rénale et Immunologie Clinique, Hôpital - Edouard Herriot, Lyon, France.
Background:
Intestinal microsporidiosis is a major cause of chronic diarrhea and malabsorption in patients with human immunodeficiency virus. Its occurrence in transplant recipients has exceptionally been reported to date.
Methods:
We report what we believe are the first two cases of intestinal microsporidiosis in renal transplant recipients. The patients were treated with mycophenolate mofetil.
Results:
The clinical presentation was chronic diarrhea with massive weight loss. Stool analysis revealed microsporidian spores, identified as Enterocytozoon bieneusi spores by polymerase chain reaction. The onset of this opportunistic infection in these two patients is believed to be secondary to an increase in immunosuppression after azathioprine replacement by mycophenolate mofetil. The withdrawal of mycophenolate mofetil led to clinical recovery.
Conclusion:
The incidence of microsporidiosis will probably increase in transplant recipients treated with powerful immunosuppressants. Therefore, we recommend a systematic search for microsporidian spores in stool specimens in cases of unexplained diarrhea in these patients.
Insights
Intestinal microsporidiosis, an opportunistic infection, can occur in renal transplant recipients. Early detection and withdrawal of immunosuppressants like mycophenolate mofetil can lead to recovery.
Area of Science:
- Infectious Diseases
- Transplantation Immunology
- Gastroenterology
Background:
- Intestinal microsporidiosis is a known opportunistic infection in human immunodeficiency virus patients.
- Its occurrence in organ transplant recipients is rare, with limited documented cases.
Observation:
- Two renal transplant recipients presented with chronic diarrhea and significant weight loss.
- Diagnosis was confirmed by identifying Enterocytozoon bieneusi spores in stool samples via polymerase chain reaction.
Findings:
- The infection onset was linked to increased immunosuppression following the replacement of azathioprine with mycophenolate mofetil.
- Clinical recovery was achieved by discontinuing mycophenolate mofetil, indicating its role in the infection's development.
Implications:
- The incidence of microsporidiosis may rise in transplant recipients due to potent immunosuppressive therapies.
- A systematic stool examination for microsporidian spores is recommended for unexplained diarrhea in this patient population.