INSUBCONTINENT EXCLUSIVE:
About two months after receiving a donated kidney, a 61-year-old man ended up back in the hospital
He was tired, nauseous, and vomiting
He was also excessively thirsty and producing too much urine
Over the next 10 days, things only got worse
The oxygen levels in his blood began to fall
His lungs filled with fluid
Doctors inserted a feeding tube
His oxygen levels and blood pressure kept falling
He was admitted to the intensive care unit and put on mechanical ventilation
Still, things kept getting worse.At that point, he was transferred to the ICU of Massachusetts General Hospital, where he had received the
He was in acute respiratory failure and shock.In a case report in this week's issue of the New England Journal of Medicine, doctors at Mass
General explained how they determined what was wrong with the man
Their first steps were collecting more information about the man's symptoms from his wife, reviewing his family medical history, and
contacting the regional organ-procurement organization that provided the kidney.The man's condition and laboratory tests suggested he had
But as a transplant recipient who was on a variety of immunosuppressive drugs, the list of infectious possibilities was "extensive."Dr
Camille Kotton, Clinical Director of the hospital's Transplant and Immunocompromised Host Infectious Diseases division, laid out her
She started with a process of elimination
As an immunosuppressed transplant patient, he was also on several medications to proactively prevent infections
These would rule out herpesviruses and cytomegalovirus
He was also on a combination of antibiotics that would rule out many bacterial infections, as well as the fungal infection Pneumocystis
jirovecii that strikes the immunocompromised and the protozoan parasite Toxoplasma gondii.One feature stood out: The man had developed
The man also had a reddish-purple rash over his abdomen
Coupled with the severity of his illness, Kotton suspected a widespread parasitic infection.The man's history was notable for contact with
But common bacterial infections linked to cat scratches could be ruled out
And other parasitic infections that might come from domestic animals in the US, such as toxocariasis, don't typically lead to such critical
