Post-Renal Transplant Miliary Mottling: Not Always Tuberculosis.

Area of Science:

• Nephrology
• Infectious Diseases
• Critical Care Medicine

Background:

• Renal transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.
• Acute cellular rejection (BANFF-IA) necessitates immunosuppressive therapy, often with glucocorticoids.
• Graft dysfunction can be a presenting symptom in post-transplant complications.

Observation:

• A 28-year-old male with a 3-year-old renal transplant presented with vomiting and graft dysfunction.
• Treatment for acute cellular rejection led to severe enterocolitis and respiratory failure.
• Imaging revealed miliary mottling, prompting further investigation.

Findings:

• Filariform larvae of Strongyloides stercoralis were identified in stool and sputum samples.
• The patient was diagnosed with Strongyloides Hyperinfection Syndrome (SHS).
• Successful treatment involved noninvasive ventilation, antimicrobials, ivermectin, and albendazole.

Implications:

• Strongyloides Hyperinfection Syndrome should be considered in immunocompromised patients with miliary mottling.
• Prompt diagnosis and aggressive treatment are vital for managing SHS in transplant recipients.
• This case underscores the importance of considering parasitic infections in the differential diagnosis of severe illness in immunosuppressed populations.