amphotericin-b and Glomerulonephritis--IGA

A 42-year-old man, with a history of immunoglobulin A nephropathy, underwent a living-related kidney transplant. Allograft function progressively deteriorated secondary to chronic rejection and recurrence of IgA nephropathy, and he returned to peritoneal dialysis after 5 years of the transplant. Fifteen months after the discontinuation of immunosuppressive therapy, Eschericia coli peritonitis developed, which was treated with ceftazidime intraperitoneally; he received fluconazole as prophylactic antifungal therapy during this period. After completing his course of treatment, abdominal pain occurred with an increased peritoneal fluid white blood cell count. Peritoneal fluid cultures were negative. He received broad-spectrum antibiotics and fluconazole with no appreciable response. After removal of the Tenckoff catheter, peritoneal fluid cultures grew a zygomycete. The patient was treated with liposomal amphotericin B (AmBisome) intravenously for 6 weeks. He had episodes of recurrent intraabdominal abscesses requiring surgical drainage and antibiotics. A second course of liposomal amphotericin B was administered for histopathologic evidence of filamentous fungal recurrence. After 5 months, the patient remains well without any evidence of infection.

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Bacteroides fragilis; Combined Modality Therapy; Drug Therapy, Combination; Fluconazole; Glomerulonephritis, IGA; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mucormycosis; Peritoneal Dialysis; Peritonitis; Recurrence