Vaccination coverage reinforced by an infectious disease consultation during pretransplant check-up in patients awaiting kidney transplantation: A randomized study.

BACKGROUND: Vaccine coverage (VC) in patients awaiting kidney transplantation is insufficient. METHODS: We performed a prospective, single-center, interventional, randomized, open-label study comparing a reinforced group (infectious disease consultation proposed) and a standard group (letter stating vaccine recommendations sent to the nephrologist) of patients in our institution awaiting renal transplantation. FINDINGS: Out of the 58 eligible patients, 19 declined to participate. Twenty patients were randomized to the standard group and 19 to the reinforced group. Essential VC increased from. 10% to 20% in the standard group and from 15.8% to 52.6% in the reinforced group (p < 0.034). The main obstacles identified were lack of vaccination traceability, refusal of an additional consultation and the journey time between home and hospital. CONCLUSION: While introduction of an infectious disease consultation during the pre-transplant check-up significantly improved VC in patients, it is time-consuming and failed to achieve a satisfactory rate of VC.

Chronic renal failure complications and management in kidney transplanted and nontransplanted patients.

BACKGROUND: Our purpose was to compare the management of chronic kidney disease (CKD) according to Kidney Disease Quality Initiative (K/DOQI) recommendations in kidney transplanted patients (T) and nontransplanted ones (NT). METHODS: Data concerning CKD complications were collected retrospectively. Patients seen in consultations in our department from May 2009 to June 2010 were selected if they had at least 6 months of follow-up, CKD stage 4 or 5, and no exclusion criteria namely hospitalization, active cancer, or infection in the 3 months before data collection. RESULTS: Fifty-eight T were compared with 85 NT matched by CKD stage (4-5). Anemia within K/DOQI target was better controlled among NT (51.2% versus 41.3%); however, ferritin levels within K/DOQI target were higher (80% T versus 51.7% NT). Average arterial blood pressure was similar in both groups but 51.7% of T were in K/DOQI target versus 41% of NT. Dyslipidemia within cholesterol K/DOQI target was better controlled in 60% (NT) versus 35% NT with 63.5% versus 38% NT within low-density lipoprotein K/DOQI targets. Phosphorus level was better controlled among T; parathyroid was better controlled in among 65% NT versus 50% T within the target level. CONCLUSION: Most complications of CKD were better managed among NT.

Severe colchicine intoxication in a renal transplant recipient on cyclosporine.

Using colchicine to treat an acute gout crisis in an organ transplant recipient (TR) on cyclosporine (CsA) may result in life-threatening intoxication. We report the case of a 59-year-old kidney transplant recipient on CsA who was treated with colchicine for acute gout crisis. Seven days later, he developed rhabdomyolysis with progressive quadriparesis, hematologic toxicity and acute renal failure. CsA inhibits P-glycoprotein resulting in decreased hepatic metabolism and renal excretion of colchicine. Colchicine and CsA withdrawal as well as appropriate supportive treatments were effective to manage all of these complications.

Hepatitis E virus-induced neurological symptoms in a kidney-transplant patient with chronic hepatitis.

It has been shown that hepatitis E virus (HEV) may be responsible for chronic hepatitis in solid-organ transplant patients. It has also been suggested that HEV may be responsible for atypical neurological symptoms during the acute phase. However, the relationship between the neurological symptoms and HEV infection was based on the detection of anti-HEV IgM in the sera. Herein, we report a case where neurological symptoms, that is peripheral nerve involvement with proximal muscular weakness that affected the four limbs joints with central nervous-system involvement and bilateral pyramidal syndrome, occurred in a kidney-transplant patient who was chronically infected by HEV. For the first time, HEV RNA was detected in the serum and cerebrospinal fluid. In addition, clonal HEV sequences were analyzed in both compartments, that is serum and cerebrospinal fluid. The discovery of quasispecies compartmentalization and its temporal association suggests that neurological symptoms could be linked to the emergence of neurotropic variants.

Amanita phalloides poisoning-induced end-stage renal failure.

Fungi poisoning is quite frequent: in particular, Amanita phalloides has life-threatening toxicity. It is responsible for fulminant hepatitis, and also has renal toxicity. Herein, we report on a patient who developed acute renal failure after ingesting A. phalloides, which required definitive renal replacement therapy, despite rapid liver injury recovery. A kidney biopsy showed massive acute tubular necrosis, mainly in the proximal convoluted tubule, and mild interstitial infiltration by mononuclear cells.

[Fulminant alveolar hemorrhage: evolution of giant cell arteritis to ANCA-positive vasculitis?]. / Hémorragie intra-alvéolaire fulminante : transformation d'une maladie de Horton en vascularite ANCA-positive?

INTRODUCTION: Giant cell arteritis (GCA) is a granulomatous vasculitis of the large and medium size vessels with a remarkable sensitivity to corticosteroids, although it may be dependent to therapy. In rare cases, a vasculitis of the medium or small-size vessels may mimic, be associated to, or follow GCA. We report a case of GCA dependent to corticosteroids that was followed five years after diagnosis by an alveolar hemorrhage leading to the diagnosis of a possible Wegener's granulomatosis. EXEGESIS: A 70-year-old man had a diagnosis of GCA fulfilling the ACR criteria in 1999. Temporal artery biopsy revealed a typical histological pattern. The initial response to corticosteroids was excellent, but the patient became dependent to corticosteroids, so he was given methotrexate from 2002. Severe alveolar haemorrhage occurred in December 2004, leading to the diagnosis of possible ANCA positive, anti-proteinase 3 positive Wegener's granulomatosis. CONCLUSION: ANCA-positive vasculitis may complicate the course of GCA. This evolution should be rapidly recognized, because its treatment differs to that of GCA.

Aspergillus fumigatus-related spondylodiscitis in a heart transplant patient successfully treated with voriconazole.

Organ transplant patients, such as heart transplant (HT) recipients, are prone to infections, among which are yeast infections. Of these, aspergillosis is usually associated with pneumopathy or facial sinusitis, and Aspergillus fumigatus is rarely responsible for osteomyelitis or spondylodiscitis. Herein we have reported a case of an 18-year-old male HT patient presenting with subacute lumbar spondylodiscitis at 6 months posttransplantation and 3 months after antirejection therapy with antithymocyte globulins. A percutaneous needle biopsy of the intervertebral disc yielded Aspergillus fumigatus. The patient had no evidence of lung aspergillosis, but did have maxillary sinusitis. He was successfully treated with voriconazole.

[Rituximab induced remission of pemphigus vulgaris: 2 cases]. / Pemphigus vulgaire évolutif sous corticoïdes et immunosuppresseurs: rémission sous rituximab. Deux observations.

INTRODUCTION: Pemphigus vulgaris frequently requires corticoids and immuno-suppressive drugs. The disease and the side effects of the drugs severely affect the quality of life, and sometime the vital prognosis of the patients. Other treatments than corticosteroids and immunosuppressive drugs are needed. EXEGESIS: We report 2 additional cases of pemphigus vulgaris uncontrolled by corticoids and immuno-suppressive drugs that responded spectacularly to rituximab. One patient had a recently onset disease, that was active despite 1,5 mg/kg/day prednisone and 1,5 g/day mycophenolate. She had a complete remission during 15 months after rituximab treatment. At relapse, another rituximab cycle led to a prompt remission. The other patient had longstanding pemphigus vulgaris complicated by cutaneous infections on prednisone (20 mg/d), immunosuppressive drugs and intravenous immune globulins. She had a prompt and complete remission after rituximab. CONCLUSION: Rituximab seems to be a promising drug for refractory pemphigus vulgaris. The benefit to risk ratio of this drug in this new indication must be precisely documented.