tacrolimus and Leishmaniasis--Visceral

We present a case report of visceral leishmaniasis in an elderly kidney transplant recipient (age, 73 years) with high intermittent fever in the 2 months before admission. Symptoms started 16 years after transplant. The patient received appropriate treatment with liposomal amphotericin and experienced transient increases in serum creatinine levels. Progression to dialysis was avoided with short duration of therapy (5 consecutive days, plus 1 more dose 1 week apart, a schedule alternative to 15-21 days [supported by the literature]) and a temporary reduction in tacrolimus exposure. After 4 months, recurrence of symptoms without other explanation required a second bone marrow aspirate; it revealed the persistence of amastigote forms. Visceral leishmaniasis is a potentially life-threatening infection; to the best of our knowledge, this is the oldest transplanted patient with a case of leishmaniasis described in the literature.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antiprotozoal Agents; Creatinine; Female; Fever; Humans; Kidney Transplantation; Leishmaniasis, Visceral; Liposomes; Male; Recurrence; Renal Dialysis; Tacrolimus; Transplant Recipients