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Rejection, Recurrence, or Something Else?

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    Liver transplant recipients face increased opportunistic infection risks. Disseminated nocardiosis can present unusually with liver issues, mimicking rejection, highlighting the need for early infection diagnosis.

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    Area of Science:

    • Hepatology
    • Transplantation Immunology
    • Infectious Diseases

    Background:

    • Liver transplantation is a life-saving treatment for end-stage liver disease.
    • Immunosuppression post-transplant increases the risk of opportunistic infections, particularly in the first year.
    • Opportunistic infections can manifest years after liver transplantation.

    Observation:

    • Disseminated nocardiosis typically affects the skin, lungs, and central nervous system.
    • This case presents an atypical Nocardia infection with predominant cholestasis and elevated liver enzymes.
    • The presentation mimicked organ rejection or recurrence of liver disease.

    Findings:

    • Nocardiosis can present with cholestasis and elevated liver enzymes in liver transplant patients.
    • This atypical presentation can be misdiagnosed as liver allograft rejection or disease recurrence.
    • Prompt identification of infectious etiologies is crucial.

    Implications:

    • Infectious causes, including opportunistic pathogens, must be considered in post-liver transplant patients with cholestasis and elevated liver enzymes.
    • Early diagnosis of atypical nocardiosis can prevent severe complications.
    • Timely diagnosis and treatment can avert graft loss, re-transplantation, and mortality.