[Severe posttransplant lung syndrome and an acute transplanted kidney rejected crisis successfully controlled]

After a brief literature survey of the immune complications after kidney transplantation, the authors report one patient with a severe febrile-intoxication and pulmonary dyspneic syndrome with abundant X-ray findings, consisting of large nodular and diffuse striped densities, moderately dense, reminding disseminated or miliary tuberculosis, or pneumonia in case of pneumocystis carini, on the background of poor physical findings and normal pCO2. The pulmonary changes disappeared after a treatment with high doses of glucocorticoids -- 6.750 mg predniso, imuran -- 3 mg/kg body weight and a combination of ampicillin, seporacin and nystatin -- for a total of 25 days. In parallel with the pulmonary syndrome an acute crisis followed for the elimination of the transplantant, which after the control of the pulmonary syndrome became particularly intense, blood urea reaching 150 mg% and creatinine -- 5.6 mg%. The crisis was inhibited by high prednison doses according to the scheme adopted at the Neccer hospital in Paris. The patient was discharged with 65 mg% urea and 1.5 mg% creatinine. The patient followed up for 10 months, continued to improve. Interesting data were obtained from the kidney during the crisis for elimination via a dynamic ventricular scintigraphy, differentiating the mechanical obstacle for urine elimination from the prolonged intrarenal transport of radioactive pharmaceutical, being characteristic for the crisis of elimination.