Management of early graft candidiasis in a kidney transplant recipient

Abstract

Balancing adequate immunosuppression with the risk of infection after renal transplantation remains a challenge. The presence of comorbidities adds to the challenge. Although infrequent, invasive fungal infections result in high morbidity and mortality risk in renal transplant recipients. This can be attributed to the intense immunosuppression in the first 6 months after renal transplantation, minimal symptomatology and the high mortality associated with fungal infections.Due to minimal available evidence, clinical judgement guides management of graft candidiasis. There is a need to develop evidence-based management guidelines for the treatment of fungal infections in renal transplants. Here, we report a case of early-onset candidiasis in a transplanted kidney and present the histological findings, multidisciplinary discussions and treatment given.

Keywords: Infections; Renal system; Renal transplantation.

Figure 1

Management of Early Graft Candidiasis in a Kidney Transplant Recipient (A) H&E (magnification ×20)—patchy and dense mixed inflammation involving the interstitium, tubules and surrounding glomeruli including lymphocytes, histiocytes, neutrophils and eosinophils. (B) PAS (magnification ×20)—numerous PAS-positive organisms within tubules, the interstitium and in Bowman’s space. (C) PAS (magnification ×40)—numerous organisms within tubules, the interstitium and in Bowman’s space. The organisms are ovoid, showing mild size variation and are intensely and uniformly PAS-positive. (D) Gram stain (magnification ×20)—the organisms stain positively for gram stain. (E) Grocott (magnification ×20)—the organisms stain positively for Grocott stain.