Korean Journal of Nephrology 1998;17(4):653-659.

신 이식 환자에서 발생한 Pneumocystis carinii 폐렴 2예 (Two Cases of Pneumocystis Carinii Pneumonia in Renal Allograft Recipients)

서광용, 김태균, 성용직, 박주현, 김영옥, 김용수, 방병기 (Kwang Yong Sung, Tae Gyun Kim, Yong Jik Sung, Ju Hyun Park, Young Ok Kim, Yong Soo Kim and Byung Kee Bang)

Abstract

Renal allograft recipients are at risk for Pneumocystis carinii pneumonia(PCP) within the first year following transplantation and during treatment for graft rejection. We experienced two cases of PCP in renal allograft recipients. The first case was a 39-year-old female who had received renal allograft 7 years before. At the time of traosplantation, she was a carrier of hepatitis B surface(HBs) antigen. After transplantation, she had been received the rnaintenance dose of cyclosporine and oral prednisolone. Three months before adrnission, dosage of prednisolone was increased because of the increased serum creatinine level and gene- ralized edema. A week before admission, syrnptom of exertional dyspnea, dry cough, and fever was developed. Chest X-ray film showed streaky interstitial infiltration in both lung fields and chest CT showed diffuse ground-glass appearance. Rroncho- alveolar lavage revealed positive Grocott's methe- namine silver stain for numerous clumps of pneu- mocystis carinii cysts. Despite the aggressive treat- ment, she died of respiratory and hepatic failure and GI bleeding. Another case was a 40-year-old male who had received renal allograft S years before. He had been received maintenance immune suppressive therapy with cyclosporine and oral prednisolone. He was admitted for evaluation of hypertension and elevated serum creatinine level. After several days of admission, he complained fever, dry cough and dyspnea. X-ray film showed pneumonic infiltration and the bronchial brushing and washing fluid revealed the Pneumocystis carinii cysts that were stained by methenamine silver. He was treated with the full dose of trimethoprim-sulfamethoxazole and clindamycin. Sacrificing the renal allograft, he recovered from Pneumocystis carinii pneumonia.