Aspergillosis osteomyelitis and joint infection in a renal transplant recipient.

Invasive Aspergillosis occurs in almost every human organ, most commonly in the lungs. Bone involvement classically has been considered exceedingly rare for both immunocompromised and immunocompetent hosts, however, there are limited data in transplant recipients. We report an unusual case of osteomyelitis and joint infection of the ankle caused by Aspergillus fumigatus in a renal transplant recipient.

HLA class I and class II antigens in Turkish patients with chronic ordinary urticaria.

BACKGROUND: Chronic urticaria is a common disease with an unclear pathogenesis, which may be resistant to therapy. Recent studies have focused primarily on a possible autoimmune basis. AIM. To investigate HLA class I and II antigens in a Turkish population with chronic ordinary urticaria (COU; not physical, vasculitic or contact), and identify susceptible HLA antigens. METHODS: HLA antigens were investigated in 55 patients diagnosed with COU, using a two-stage microdroplet lymphocytotoxicity test, with 104 healthy and genetically unrelated individuals evaluated as the control group. RESULTS: HLA Bw4 and HLA DQ1 antigens were significantly higher in the study group (odds ratio (OR) = 2.93, 95% CI 1.47-5.85, P = 0.003 and OR = 7.81, 95% CI 1.96-28.50, P = 0.001, respectively) whereas HLA-A24 antigen was higher in controls (OR = 0.36, 95% CI 0.15-0.86, P = 0.03). CONCLUSION: We propose that HLA-Bw4 and DQ1 antigens may be responsible for susceptibility to COU while HLA-A24 may have a protective role in the Turkish population.

Primary central nervous system lymphoma in a renal transplant recipient with Bardet-Biedl syndrome.

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive disorder. End-stage renal failure has been reported as the most frequent cause of death in this disorder. There are few reports of kidney transplantation in these patients. Renal transplant patients are known to be at increased risk for the development of malignancies. Although a few patients with BBS have been described to develop malignant disease, there was no previous association with lymphoma. We report a 20-year-old patient in whom primary central nervous system lymphoma was diagnosed 20 months after renal transplantation.

Aspergillus pneumonia in renal transplant recipients at a medical center in Turkey.

Pulmonary aspergillosis is a devastating disease. Early diagnosis allowing early treatment may improve the prognosis. However, this goal remains difficult to achieve. When the diagnosis is confirmed, it is often already too late. Despite antifungal treatment, the mortality rate is high. Patients with immunosuppression show a high mortality rate. We present five patients of ages ranging between 34 and 43 years who displayed aspergillus pneumonia between 1991 and 2000. All patients received cyclosporine, azathioprine, and prednisone for maintenance immunosuppressive therapy. Their ages ranged from 34 to 43 years with the onset of infection between 1 to 25 months posttransplant. In all cases, the infection was localized to the lungs. Standard methods of fungal culture and identification were used. No coinfections with tuberculosis or other fungi or bacteria were identified. Three cases were successfully treated but two patients showed deterioration despite appropriate therapy and died. Among patients with solid organ transplantation, lung, liver, and renal transplant patients are at the highest risk of developing aspergillus lung infections. A high degree of awareness and efforts for early diagnosis and therapy may improve the poor prognosis.