Clinical listeriosis in renal allotransplantation

Two cases of Listeria monocytogens meningitis among 212 kideney transplanted patients (total of 339 patient years of observation) under immunosuppression with azathioprine and prednisone are presented. Both cases developed shortly after an increase of the immunosuppression. The first case appeared in a 27-year-old man 5 days after a minor increase of the azathioprine dose from 75 to 100 mg/day. The course was relatively mild, and the patient was cured by tetracycline. The second case appeared in a 52-year-old woman 5 days after a massive increment of the steroid dose and adminsteration of a moderate azathioprine dose, carried out to revert a rejection of the graft. This case had a fulminant course and was complicated by Listeria sepsis with hemolysis, pronounced oliguria and thrombocytopenia leading to fatal internal bleedings, primarily in the brain. Considering the poor prognosis of this complication it is suggested that cytotoxic drugs are temporarily discontinued and the steroid dose reduced at the height of the infection.