Complex considerations - Fever and pancytopenia after solid organ transplantation

Area of Science:

• Transplant Immunology
• Infectious Diseases
• Hematology

Background:

• Kidney transplantation is a life-saving procedure.
• Immunosuppression post-transplant increases infection risk.
• Donor-derived infections are a rare but serious complication.

Observation:

• A 42-year-old male kidney transplant recipient presented with fever, pancytopenia, and abnormal liver function tests on post-operative day 9.
• Extensive diagnostic workup was performed.
• The patient was diagnosed with donor-derived toxoplasmosis.

Findings:

• The toxoplasmosis was associated with hemophagocytic lymphohistiocytosis (HLH) in the recipient.
• This occurred in a high-risk donor-positive/recipient-negative (D+/R-) mismatch.
• Diagnosis was confirmed through microbiologic and molecular testing.

Implications:

• This case underscores the risk of post-transplant toxoplasmosis in D+/R- kidney transplant recipients.
• It emphasizes the critical role of Toxoplasma-specific prophylaxis in preventing such severe complications.
• Early diagnosis and targeted treatment are crucial for managing donor-derived infections in transplant recipients.