Assuntos
Betacoronavirus , Telemedicina , COVID-19 , Infecções por Coronavirus , Pandemias , Pneumonia Viral , SARS-CoV-2RESUMO
We describe a case of cardiac toxoplasmosis diagnosed by routine endomyocardial biopsy in a patient with trimethoprim-sulfamethoxazole (TMP-SMX) intolerance on atovaquone prophylaxis. Data are not available on the efficacy of atovaquone as Toxoplasma gondii prophylaxis after heart transplantation. In heart transplant patients in whom TMP-SMX is not an option, other strategies may be considered, including the addition of pyrimethamine to atovaquone.
Assuntos
Transplante de Coração , Miocárdio/patologia , Complicações Pós-Operatórias/patologia , Toxoplasmose/patologia , Adulto , Anti-Infecciosos/uso terapêutico , Atovaquona/uso terapêutico , Biópsia , Humanos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Toxoplasmose/etiologia , Toxoplasmose/prevenção & controleRESUMO
Antithymocyte globulin (ATG) is a preparation of polyclonal antibodies frequently used to treat acute cellular rejection in organ transplant recipients. Use of rabbit ATG has been associated with serum sickness in liver and kidney transplantation patients previously exposed to rabbits. Here, we report the case of a heart transplantation patient with a history of significant rabbit exposure who had developed migratory diffuse arthralgias 13 days after receiving ATG for acute cellular rejection. Laboratory findings included C-reactive protein elevation, depressed levels of C3 and C4 complement, and strongly positive titers against rabbit immunoglobulin G, all strongly suggestive of serum sickness. To our knowledge, this is the first report of delayed serum sickness related to rabbit ATG after prior rabbit exposure in an adult heart transplantation patient. Early recognition of the symptoms of serum sickness can lead to prompt and appropriate management.
Assuntos
Soro Antilinfocitário/efeitos adversos , Cardiomiopatia Dilatada/cirurgia , Rejeição de Enxerto/terapia , Transplante de Coração/efeitos adversos , Imunoglobulina G/imunologia , Doença do Soro/etiologia , Animais , Soro Antilinfocitário/imunologia , Proteína C-Reativa/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Coelhos , Doença do Soro/diagnósticoRESUMO
Nesiritide, an intravenous form of human B-type natriuretic peptide, has been approved as treatment for patients with acute decompensated heart failure. Due to its action on different receptors, nesiritide has many effects, including vasodilation and natriuresis. Cardiac preload and afterload decrease, leading to an increase in cardiac output through effects on smooth muscle and the kidneys. As a bridge to cardiac transplantation, nesiritide has been used to maintain vasodilation and diuresis without sacrificing kidney function. Our patient, prior to multi-organ transplantation, had a pulmonary capillary wedge pressure of 41 mm Hg on milrinone monotherapy, which decreased slightly with nitroprusside and further decreased to 4 mm Hg after the addition of nesiritide. The patient's measured creatinine clearance level was calculated to be 40 mL/min. When nesiritide therapy was begun, the renal function did not improve, but, as the hemodynamics improved, renal function did not decrease.