NDT Advance Access originally published online on March 26, 2007
Nephrology Dialysis Transplantation 2007 22(7):2099-2100; doi:10.1093/ndt/gfm040
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Neisseria-cinerea-induced pulmonary cavitation in a renal transplant patient
Email: kamar.n{at}chu-toulouse.frSir,
Neisseria cinerea is a commensal microbe that colonizes the nasal and oropharynx cavities [1], generally considered to be a non-pathogenic organism. Nevertheless, it has been described as an aetiological agent responsible for various diseases. Herein, we report the first case of N. cinerea related pulmonary cavitation to occur in a male renal transplant patient. A routine chest radiography, performed 16 months after transplantation in a 58-year-old renal transplant patient, revealed the presence of de novo cavitation located in the upper lobe of the right lung. A computed tomography (CT) scan showed a single mass in the right upper lobe with a large cavitation and a thick margin (Figure 1A), without lymphadenopathy. At that time, the patient had been complaining of an intermittent non-productive cough and fatigue for a few days, and a low-degree fever (38°C). C-reactive protein was 80 mg/l (N < 15 mg/l), and serum creatinine was unchanged (225 µmol/l). His immunosuppressive therapy was based on the combination of sirolimus (trough level 9 ng/ml) and steroids (5 mg/day). Blood and urine cultures, as well as fluid obtained from gastric aspirations, induced-sputum and bronchoalveolar lavage (BAL) were negative for bacteria, mycobacteria including anti-fast bacilli and fungi (culture and polymerase chain reaction). No anaerobic agent grew on specific culture media. Aspergillus antigenaemia was negative. A transthoracic CT-guided biopsy of the peripheral component of the cavity and an aspiration of fluid were performed (Figure 1B). The fluid aspirated from the cavity was inflammatory. Pathological analysis of the biopsy showed a fibrino-inflammatory pulmonary tissue without any granuloma or malignant cells. The culture of the biopsy grew a Gram-negative, oxidase-positive diplococcus, which was further identified as N. cinerea (Apisystem, BioMérieux, France). The patient was treated with amoxycillin at 2 g three times per day for 3 weeks. The fever disappeared, and C-reactive protein returned to normal range 9 days later. Another CT scan, performed 15 days after starting amoxycillin therapy, showed that the margins were thinner and the cavitation represented the majority of the lesion (Figure 1C, D). Finally, an antero-posterior chest radiography and a CT scan, performed 3 months after completion of amoxycillin therapy, showed a residual cystic lesion with a thin margin (Figure 1E, F). Close monitoring of Aspergillus antigenaemia at 2-monthly intervals was initiated. After 1 year of follow-up, the patient had not presented with a relapse or any symptomatic pulmonary manifestations, though the cavitation was still evident on the CT scan.
|
The main infectious causes of lung cavitation in transplant recipients are aspergillosis, tuberculosis and nocardiosis [2]. In transplant patients in whom a cavitary lung lesion is demonstrated, if a complete investigation procedure including BAL does not yield a pathogen, one should consider performing a transbronchial biopsy or a transthoracic needle aspiration under CT guidance when a lesion is accessible.
Conflict of interest statement. None declared.
1Department of Nephrology
Dialysis and Multi-Organ
Transplantation
2Department of Radiology
3Department of Microbiology
CHU Rangueil Toulouse
University Hospital, France
References
- Knapp JS, Hook EW. Prevalence and persistence of Neisseria cinerea and other Neisseria spp. in adults. J Clin Microbiol (1988) 26:896–900.
[Abstract/Free Full Text] - Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med (1998) 338:1741–1751.
[Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||