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Transmission of cryptococcosis by liver transplantation:A case report and review of literature

World Journal of Hepatology 2020年第5期12卷 253-261页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli fernando marcus felippe jorge Carolina de Fatima Couto Priscila Brizolla de Campos Gabriel Oliveira Nunes Caja Department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70673900Brazil

BACKGROUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans(***)species *** fungi are ubiquitous in soil and bird droppings,and infection by them is an important global health concern,particularly in immunosuppressed patients,such as organ transplant recipients and those infected by the human immunodeficiency *** fungus usually enters the body through the respiratory tract,but extremely rare cases of infection acquired by transplantation of solid organs have been *** SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient,diagnosed 2 wk after the *** patient initially presented with fever,hyponatremia and elevated transaminase levels,manifesting intense headache after a few *** cultures were positive for *** biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous *** resonance imaging of the brain showed multiple small lesions with low signal in T2,peripheric enhancement and edematous halo,diffuse through the parenchyma but more concentrated in the subcortical *** with amphotericin B for 3 wk,followed by maintenance therapy with fluconazole,led to complete resolution of the *** recipients of both kidneys from the same donor also developed disseminated cryptococcosis,confirming the transplant as the source of *** organ donor lived in a rural area,surrounded by tropical rainforest,and had negative blood cultures prior to organ *** This case highlights the risk of transmission of fungal diseases,specifically of ***,through liver graft during liver transplantation.

关键词： Cryptococcosis Liver transplantation Cryptococcus neoformans Case report Immunosuppression Fungal infection

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Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

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World Journal of Hepatology 2019年第4期11卷 402-408页

作者： Gustavo de Sousa Arantes Ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli fernando marcus felippe jorge Luiz Gustavo Guedes Diaz Milla Carolina Costa Lafeta Araujo Gabriela de Campos Araujo Amanda de Castro Machado Department of Liver Transplantation Instituto de Cardiologia do Distrito Federal Curso de Medicina Universidade Catolica de Brasilia

BACKGROUND Infection by the hepatitis C virus(HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver *** SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid *** biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1 A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the *** This case highlights the difficulties of diagnosing skin lesions caused by HCVinfection in immunosuppressed patients.

关键词： Hepatitis C Liver transplantation Leukocytoclastic vasculitis Immunosuppression Direct-acting antivirals Case report

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