An Interesting Case of Kidney Transplant Recipient with Multiple Concomitant Infections- 10 Years Post Transplantation

Opportunistic infections or pathogens that reactivate from latent infection in the renal transplant recipients often arise during the peak immunosuppression period and infections such as Pneumocystis jirovecii may arise in the late period of posttransplant. In developing countries, tuberculosis (TB) is a major concern among transplant patients. Here, we present a case of 42-year-old male who presented after 10 years of renal transplant with a history of fever. On evaluation, he was diagnosed to have concomitant multiple infections like disseminated TB, Cryptococcal meningitis, Cytomegalovirus viremia, and Pneumocystis infection. He was treated with appropriate antibiotics, antifungal, and antiviral with close monitoring of drug-related side effects and graft function. Detailed evaluation and to look for concomitant infections is required for transplant patients who had no response to one particular group of drugs after initial diagnosis. He had stable graft function and developed drug-related side effects which required dose reduction intermittently. This case taught us how to manage four major infections with balancing immunosuppression, antibiotics, and graft function that we see in day-to-day practice of transplant clinics.