Analysis of Diagnosis and Treatment of Pulmonary Infection with Pneumocystis Jirovecii and Cryptococcus Neoformans in One Patient after Renal Transplantation
Objective:To analyze the diagnosis and treatment process of pulmonary infection with Pneumocystis jirovecii and Cryptococcus neoformans in patients after renal transplantation,and provide a reference for the diagnosis and treatment of fungal infections in such immunosuppressed patients in the clinical practice.Methods and Results:One patient who had been taking immunosuppressants for a long time after renal transplantation visited the hospital due to"chest tightness,shortness of breath,and poor appetite for more than 20 days".According to the chest CT result,the patient was considered to have community-acquired pneumonia.After admission,the patient's routine blood test,routine biochemical test,and arterial blood gas analysis showed no obvious abnormalities except for a high creatinine level.However,2 days later,the cryptococcal capsular polysaccharide antigen test reported positive result,the(1,3)-β-D-glucan test reported positive result.Cryptococcal fungal spores and a small amount of Pneumocystis jirovecii were found in the smear and methenamine silver staining of the alveolar lavage fluid.The next-generation sequencing(NGS)on alveolar lavage fluid showed positive fungi(Cryptococcus neoformans and Pneumocystis jirovecii).Therefore,the patient was diagnosed with fungal pneumonia caused by Cryptococcus neoformans and Pneumocystis jirovecii,and fluconazole and compound sulfamethoxazole were given immediately.After about one week,the patient's creatinine level continued to rise.In order to reduce the impact on the patient's renal function,the dosage of fluconazole and the dosing frequency of compound sulfamethoxazole were reduced;then after 18 days,the patient's symptoms of chest tightness and shortness of breath had been relieved obviously,and the creatinine level was significantly decreased,so the patient was allowed to be discharged.After more than 3 months,the patient's chest CT showed that the lesions were significantly absorbed or improved.Conclusion:Mixed pulmonary fungal infection is relatively rare in clinical practice,and it is extremely dangerous for immunocompromised patients if it is not well managed.Therefore,it is extremely important to complete the examinations and make an early definite diagnosis for the treatment and prognosis of patients.
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