Penicilliosis in lupus patients presenting with unresolved fever: a report of 2 cases and literature review.

Penicilliosis is a rare occurrence among non human immunodeficiency virus (HIV) infected patients. We report here two cases of Penicillium marneffei infection in patients with systemic lupus erythematosus (SLE). Both patients had a recent flare of lupus and were on immunosuppressive drugs when they presented with prolonged fever without an obvious foci of infection, unresponsive to broad-spectrum antibiotics. They were leucopaenic upon admission, with rapid deterioration during the course of the illness. Diagnosis of penicilliosis via fungal isolation from blood culture was delayed resulting in the late initiation of antifungal agents. While both patients ultimately recovered, the delay in diagnosis led to a prolonged hospital stay with increased morbidity. Clinicians should be aware of this uncommon but emerging fungal pathogen in SLE patients and maintain a high index of suspicion in diagnosing this potentially fatal but treatable disease.

Pneumocystis jirovecii pneumonia 13 years post renal transplant following a recurrent cytomegalovirus infection.

Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia (PCP) is a rare but serious infection that usually occurs within a year after solid organ transplantation. PCP may occur after 1 year post transplantation, but the rate is reported to be very low. Studies have shown an association between cytomegalovirus (CMV) infection in solid organ transplant patients and an increased risk of opportunistic infection. This increased risk is thought to be a result of the immunomodulatory effects of the CMV infection. We present a case of PCP infection occurring 13 years after a renal transplantation. This occurred following a recurrent CMV infection while the patient was on low-dose immunosuppressants.

Grossly delayed graft function in a living related kidney transplant recipient: a case report.

Delayed graft function is a potentially challenging problem especially in cadaveric kidney transplant recipients. It adversely impacts long-term graft survival. It is rarely seen in living kidney transplants. Recovery of graft function usually occurs within a month. The chances of recovery of graft function diminish with further prolongation of delayed function. In fact, recovery of graft function after 3 months has rarely been described, we report herein recovery of graft function after 132 days of nonfunction in a living related kidney transplant.

Fever in children with acute lymphoblastic leukemia.

In this study among children with acute lymphoblastic leukemia, more febrile episodes occurred during induction of remission and relapse than during remission. Infection was mainly responsible for fever during remission, regardless of the neutrophil count. However, during induction and relapse, evidence suggests that the underlying malignancy is the more likely cause of fever if the neutrophil count exceeds 200 per mm3. For all cases, the risk of serious infection was high with severe neutropenia (neutrophil count less than 200 per mm3). Of the organisms identified, gram-positive and gram-negative bacteria were equally represented. Infection remains a serious problem in the management of children with leukemia.