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Tubulointerstitial Nephritis Post-Microsporidium Infection in a Combined Liver-Kidney Transplanted Patient: A Case
Alfonso Gindl-Bracho1, Hector O Rivera-Villegas2, Norma O Uribe-Uribe3
1Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
Abstract:
Microsporidia are emerging opportunistic pathogens in immunosuppressed individuals, including solid organ transplant recipients. We present a case of tubulointerstitial nephritis (TIN) caused by Microsporidia infection in a 55-year-old male who underwent combined liver-kidney transplantation (CLKT) for metabolic-associated fatty liver disease and end-stage kidney disease. The patient developed diarrhoea, abdominal bloating and acute kidney injury (AKI) 1 month post-transplant. A kidney biopsy revealed granulomatous TIN with 50% interstitial fibrosis and 60% tubular atrophy. Stool examination confirmed Microsporidia infection. Treatment with albendazole over 6months led to gradual renal function recovery. This case highlights the risk of Microsporidia infections in CLKT recipients, presenting as a rare but serious cause of graft dysfunction and AKI. Early diagnosis and treatment, including reduction in immunosuppression and antiparasitic therapy, are essential for improving outcomes in these patients. To our knowledge, this is the first report of Microsporidia infection in a CLKT recipient globally.
Insights
Microsporidia infections can cause serious kidney problems in transplant patients. Early diagnosis and treatment with albendazole improved graft function in a rare combined liver-kidney transplant case.
Area of Science:
- Infectious Diseases
- Nephrology
- Transplantation Immunology
Background:
- Microsporidia are opportunistic pathogens increasingly recognized in immunocompromised individuals.
- Solid organ transplant recipients, particularly those undergoing combined liver-kidney transplantation (CLKT), are at risk for opportunistic infections.
Observation:
- A 55-year-old male CLKT recipient presented with diarrhea, bloating, and acute kidney injury (AKI) one month post-transplant.
- Kidney biopsy showed granulomatous tubulointerstitial nephritis (TIN) with significant fibrosis and tubular atrophy.
- Stool examination confirmed Microsporidia infection.
Findings:
- Microsporidia infection was diagnosed as the cause of AKI and graft dysfunction in this CLKT recipient.
- Treatment with albendazole resulted in gradual recovery of renal function over six months.
- This represents the first reported case of Microsporidia infection in a CLKT recipient worldwide.
Implications:
- Microsporidial infections pose a rare but significant threat to graft survival and renal function in CLKT recipients.
- Prompt diagnosis through stool examination and kidney biopsy is crucial for effective management.
- Combined therapeutic strategies, including antiparasitic treatment and immunosuppression adjustment, are vital for favorable outcomes.
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Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Fungal Phylum Microsporidia

