- A 61-year-old kidney transplant recipient developed severe infection two months post-surgery
- Patient showed symptoms of infection, low oxygen, fluid in lungs, and elevated eosinophils
- Donor was from the Caribbean, where Strongyloides parasite is common, and donor blood had antibodies
A 61-year-old man thought he was on his way to recovery after receiving a donated kidney, but his life soon took a turn for the worse. Two months after the transplant procedure, the man was back in the hospital -- feeling tired and nauseous while vomiting. Additionally, he was thirsty and urinating all the time.
As per the case report in this week's issue of the , the patient's oxygen levels in the blood had started to fall and the lungs were filled with fluid. Doctors inserted a feeding tube, but the oxygen levels and blood pressure kept falling. Eventually, he was admitted to the ICU.
With the patient's condition deteriorating, the doctors at Mass General started the process of elimination to figure out the root cause of the problem. The wife was contacted for more information, while the regional organ-procurement organisation that provided the kidney was also called up for more insights.
In the meantime, the lab reports suggested that the patient had some sort of infection. However, since the patient was a recent kidney recipient and on a variety of immunosuppressive drugs, the list of infectious possibilities was "extensive".
Dr Camille Kotton, Clinical Director of the hospital's Transplant and Immunocompromised Host Infectious Diseases division, went through the patient's history and ruled out herpesviruses and cytomegalovirus, as some of the medications would have proactively prevented these infections, according to a report in Ars Technia.
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The investigation
While analysing the patient, Dr Kotton noticed that he had elevated levels of eosinophils, white blood cells that can increase for various reasons, including parasitic infections. He also had a reddish-purple rash over his abdomen, which prompted Dr Kotton to suspect a parasitic infection.
Strongyloides, a parasitic roundworm that infects the gastrointestinal tract, was suspected as the cause of the patient's problems. To test the hypothesis, Dr Kotton called the organ-procurement organisation and found that the donor was from the Caribbean, where Strongyloides are present.
The donor's blood was not tested for the infection before the transplant, but blood samples showed antibodies against the parasite. The transplant patient's pre-transplant blood samples, on the other hand, were negative.
After the confirmation, doctors conducted the tests, which revealed that the patient had worm larvae in the lungs and stool. To treat such a widespread infection, they had to use a deworming drug called ivermectin, which is only approved by the Food and Drug Administration for oral formulations in humans.
After receiving special approvals, the ivermectin was delivered subcutaneously to the patient. While the patient recovered, doctors received a message that the person who received the donor's other kidney was also critically ill.
The doctors shared notes, and both patients managed to make a full recovery. The case prompted the United Network for Organ Sharing to update its policy to recommend universal screening for Strongyloides.
