Pneumocystis Pneumonia after Kidney Transplantationin Children

ABSTRACT

Pneumocystis pneumonia (PCP) is a rare disease in healthy people but a potentiallyfatal opportunistic infection by Pneumocystis jirovecii in immunocompromisedpatients with organ transplantation. We present three cases of PCP after kidneytransplantation in pediatric patients. First case was a 4-year-old boy diagnosedwith Denys-Drash syndrome and received living-donor kidney transplantationfrom his mother at age of 1. Second case was a 19-year-old male, with polycystickidney disease, who received kidney transplantation from his mother at the age of18. Third case was a 19-year-old female with chronic kidney disease of unknownetiology, who received kidney transplantation from her father at age of 15. Thesethree patients who were on immunosuppressive therapy and completed ofroutine PCP prophylaxis for 6 months had presented with cough and dyspneamore than 1 year after transplantation. Chest x-ray all showed diffuse haziness ofboth lung fields, and bronchoalveolar lavage from bronchoscopy revealed Pneumocystisjirovecii infection. All patients showed clinical resolution with intravenoustrimethoprim-sulfamethoxazole (TMP-SMX) therapy for at least 3 weeks and hadcontinued secondary prophylaxis for another 6–12 months. This report suggeststhat clinicians should have suspicion for the possibilities of opportunistic infectionsuch as PCP after kidney transplantation in children.