肾移植术后,反复发热、腹泻、腹膜后淋巴结肿大

Recurrent fever,diarrhea and retro-peritoneal lymphadenopathy in a kidney transplant recipient

中年男性,肾移植术后服用泼尼松、环孢素、硫唑嘌呤及雷公藤多苷片等抗排斥治疗,既往曾患新生隐球菌病(累及肺部及中枢神经系统),氟康唑及伊曲康唑抗真菌治疗后痊愈,后续泼尼松联合吗替麦考酚酯、他克莫司抗排斥。近4月出现反复发热伴腹泻,PET-CT提示全身多处淋巴结代谢增高,多次痰及尿液找抗酸杆菌阳性,腹腔淋巴结活检提示"鸟型胞内分支杆菌假瘤",最终诊断为播散性鸟胞内分枝杆菌复合体感染,经治疗后病情稳定。

A 45-year-old male kidney transplant recipient who kept a long-term immunosuppressive agents consisted of prednisone,cyclosporine,azathioprine and tripterygium wilfordii. He had a post-transplantation infection experience： adequately treated cryptococcus neoformans infection involved lung and central nervous system with the agents of fluconazole and sporanox. After cryptococcus neoformans infection cured,his immunosuppressive regimen changed into the combination of prednisone,mycophenolate mofetil and tacrolimus. Four months lately,he was suffered with recurrent fever which mainly occurred at night and persistent diarrhea. Acid fast bacilli were found several times in his sputum and midstream urine specimen. PET-CT showed a lot of lymphonodus with high metabolic rate. The celiac lymph node histological examination showed highly considered mycobacterium avium-intracellulare complex pseudotumor. The final diagnosis is mycobacterium avium-intracellulare complex disseminated infection.