Intravenous immunoglobulin as adjunctive therapy in kidney transplant recipients with severe pneumocystis pneumonia

Area of Science:

• Medicine
• Immunology
• Infectious Diseases

Background:

• Pneumocystis jirovecii causes severe pneumonia in immunocompromised individuals, particularly kidney transplant recipients.
• Pneumocystis pneumonia (PCP) can occur late post-transplant despite prophylaxis, often with high mortality.
• Limited evidence-based options exist for intensifying treatment when standard therapy fails.

Observation:

• Two cases of severe PCP in high immunological risk kidney transplant recipients are presented.
• Patients received adjunctive intravenous immunoglobulin and had their immunosuppression withdrawn.
• Both patients experienced recovery and were discharged with functioning kidney grafts.

Findings:

• Adjunctive intravenous immunoglobulin combined with immunosuppression withdrawal can be an effective strategy for managing severe PCP in high-risk kidney transplant patients.
• This approach facilitated patient recovery and graft survival.

Implications:

• This case series suggests a potential therapeutic avenue for severe PCP in immunocompromised patients, especially those post-transplant.
• Further research is warranted to validate the efficacy and safety of this combined treatment approach.
• Minimizing immunosuppression while using adjunctive therapies may be crucial for managing severe infections without compromising graft integrity.