BACKGROUND: Pneumocystis pneumonia (PCP) is a life-threatening pulmonary fungal infection that predominantly affects immunocompromised individuals, including kidney transplant recipients. Recent years have witnessed a rising incidence of PCP in this vulnerable population, leading to graft loss and increased mortality. Immunosuppression, which is essential in transplant recipients, heightens susceptibility to viral and opportunistic infections, magnifying the clinical challenge. Concurrently, the global impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been profound. Kidney transplant recipients have faced severe outcomes when infected with SARS-CoV-2, often requiring intensive care. Co-infection with COVID-19 and PCP in this context represents a complex clinical scenario that requires precise management strategies, involving a delicate balance between immunosuppression and immune activation. Although there have been case reports on management of COVID-19 and PCP in kidney transplant recipients, guidance on how to tackle these infections when they occur concurrently remains limited.
METHODS: We have encountered four kidney transplant recipients with concurrent COVID-19 and PCP infection. These patients received comprehensive treatment that included adjustment of their maintenance immunosuppressive regimen, anti-pneumocystis therapy, treatment for COVID-19 and other infections, and symptomatic and supportive care. After this multifaceted treatment strategy, all of these patients improved significantly and had favorable outcomes.
CONCLUSIONS: We have successfully managed four kidney transplant recipients co-infected with COVID-19 and PCP. While PCP is a known complication of immunosuppressive therapy, its incidence in patients with COVID-19 highlights the complexity of dual infections. Our findings suggest that tailored immunosuppressive regimens, coupled with antiviral and antimicrobial therapies, can lead to clinical improvement in such cases. Further research is needed to refine risk assessment and therapeutic strategies, which will ultimately enhance the care of this vulnerable population.

Epidermal necrolysis is a severe dermatological condition usually associated with adverse drug reactions involving the mucosa. Stevens-Johnson syndrome (SJS) is clinically diagnosed when an epidermal detachment of less than 10% of body surface area (BSA) is involved. In contrast, toxic epidermal necrolysis (TEN) is characterized when there is an epidermal detachment of more than 30% BSA. Epidermal necrolysis can be described as ulcerated, painful, and erythematous lesions typically appearing on the skin. Typical clinical presentations of SJS include epidermal detachment of less than 10% of BSA and mucosal involvement with prodromal flu-like symptoms. Atypical presentations of focal epidermal necrolysis include the presence of lesions in a dermatomal pattern, associated itching, and idiopathic cause. We report a rare case of suspected herpes-zoster virus (HZV)-like SJS with negative HZV serum PCR and negative varicella-zoster virus (VZV) biopsy immunostaining. This rare case of SJS was resolved with the administration of IV acyclovir and Benadryl.

Kidney transplant recipients (KTRs) represent a vulnerable group of patients who develop a number of comorbidities. Severe periodontitis (SP) is associated with the most common chronic systemic diseases including kidney diseases. The objective of this study was to explore the risk factors for SP in KTRs.
In this study, KTRs were divided into those with or without periodontitis and in relation to the severity of periodontitis. A comprehensive medical and periodontal examination was performed and evaluated. Multivariate logistic regression was performed to examine possible risk factors for SP among KTRs.
A total of 100 KTRs were included in the analysis, of which 87% had periodontitis. Significant predictors of periodontitis were older age (OR = 1.07, 95% CI [1.01, 1.13], p = 0.016) and lower skeletal muscle mass (OR = 0.88, 95% CI [0.78, 0.99], p = 0.035). When examining periodontitis severity, predictors of SP (n = 21, 24%) were increased levels of uric acid (OR = 1.01, 95% CI [1.00, 1.02], p = 0.022) and dental plaque (OR = 1.04, 95% CI [1.01, 1.07], p = 0.013). In the subset analysis that included only KTRs with measured advanced glycation end products (AGE) (n = 47), 34% (n = 16) had SP. The predictors of SP were AGE (OR = 3.89, 95% CI [1.28, 11.82], p = 0.017) and dental plaque (OR = 1.07, 95% CI [1.01, 1.13], p = 0.028).
KTRs with SP had significantly higher uric acid levels and AGE, which may contribute to the systemic health status of this patient population.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in large-scale devastation. Reports of COVID-19 in patients with compromised immunity are available in the literature. The compromised immunity could be due to multiple factors like drug induced as in organ transplant patients, diabetes, HIV, etc. Post-transplant patients with compromised immunity due to immune suppression are vulnerable to many infections (tuberculosis, hepatitis B and C, etc.). Herein a case of an Indian male with a kidney transplant is presented who had concurrent infections of pulmonary and extrapulmonary tuberculosis due to Mycobacterium tuberculosis, hepatitis C virus, and severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). A detailed history with laboratory workup was done to establish the diagnosis and a prompt treatment was initiated for the three infections. To the best knowledge of the author, no such case has ever been reported in the medical literature to date. The management of this rare case is highlighted in this present write-up.

COVID-19 infection is considered to cause high mortality in kidney transplant recipients (KTR). Old age, comorbidities and acute kidney injury are known risk factors for increased mortality in KTR. Nevertheless, mortality rates have varied across different regions. Differences in age, comorbidities and varying standards of care across geographies may explain some variations. However, it is still unclear whether post-transplant duration, induction therapy, antirejection therapy and co-infections contribute to increased mortality in KTR with COVID-19. The present study assessed risk factors in a large cohort from India.
A matched case-control study was performed to analyze risk factors for death in KTR (N = 218) diagnosed with COVID-19 between April 2020 to July 2021 at the study centre. Cases were KTR who died (non-survivors, N = 30), whereas those who survived were taken as controls (survivors, N = 188).
A high death-to-case ratio of 13.8% was observed amongst study group KTR infected with COVID-19. There was a high incidence (12.4%) of co-infections, with cytomegalovirus being the most common co-infection among non-survivors. Diarrhea, co-infection, high oxygen requirement, and need for mechanical ventilation were significantly associated with mortality on regression analyses. Antirejection therapy, lymphopenia and requirement for renal replacement therapy were associated with worse outcomes.
The mortality was much higher in KTR who required mechanical ventilation and had co-infections. Mortality did not vary with the type of transplant, post-transplant duration and usage of depletion induction therapy. An aggressive approach has to be taken for an early diagnosis and therapeutic intervention of associated infections.

UNASSIGNED: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic and prevalent fungal infection in immunocompromised hosts, including patients after kidney transplantation (KTx). It is a life threatening infection. While with effective prophylaxis it became less common, it still remains an issue among solid organ transplant (SOT) recipients during the first year. There are no specific clinical signs for PCP. Computed tomography (CT) is a better method for detecting PCP, but definite diagnosis can only be made by identification of the microorganism either by a microscopy or by a polymerase chain reaction (PCR).
UNASSIGNED: We present a case of a 17 year old with severe PCP 13 months after KTx followed by reduction in kidney function and respiratory compromise. The pathogen was detected by PCR from bronchoalveolar lavage fluid (BALF) and patient was treated successfully with trimethoprim-sulfamethoxazole (TMPSMX). Patient\'s condition, respiratory status and kidney function gradually improved. Our presented case is unusual because patient had no known risk factors for PCP and he was more than one year after KTx, what is considered rare. In addition patient and his parents delayed in notifying the treating physician about ongoing symptoms because did not deem them important enough.
UNASSIGNED: Clinicians treating patients in risk groups for PCP must always remain vigilant even in era of effective prophylaxis. The vigilance should also extend to the patient and patient\'s family.
UNASSIGNED: Santrauka. Apžvalga.: Pneumocystis jirovecii pneumonija (PJP) yra oportunistinė grybelinė infekcija, paplitusi tarp pacientų, kurių imuninė sistema yra susilpnėjusi, įskaitant pacientus po inkstų transplantacijos (Tx). Tai gyvybei pavojinga infekcija. Nors dėl veiksmingos profilaktikos infekcija tapo mažiau paplitusi, ji vis dar aktuali dėl galimo plitimo tarp solidinių organų transplantacijos recipientų. Konkrečių PJP klinikinių požymių nėra. Kompiuterinė tomografija yra geresnis PJP nustatymo metodas, tačiau neklystamai diagnozuoti galima tik identifikuojant mikroorganizmą mikroskopu arba polimerazės grandininės reakcijos (PGR) metu.Klinikinis atvejis.: 17 metų pacientui diagnozuota sunki PJP, inkstų funkcijos pablogėjimas, kvėpavimo nepakankamumas, praėjus 13 mėnesių po inkstų Tx. Ligos sukėlėjas nustatytas iš bronchoalveolinio lavažo skysčio PGR metodu ir pacientas sėkmingai gydytas trimetoprimu ir sulfametoksazolu. Paciento bendra būklė, kvėpavimo funkcija ir inkstų funkcija pamažu pagerėjo. Pateiktas atvejis yra neįprastas, nes pacientas neturėjo jokių žinomų PJP rizikos veiksnių ir buvo daugiau nei vieneri metai praėję po inkstų Tx. Galimai turėjo įtakos paciento ir jo tėvų vėlyvas kreipimasis, nes jie nesuprato pradinių simptomų prasmės ir reikšmingumo.Išvados.: Gydytojai, gydantys PJP rizikos grupių pacientus, visada turi būti budrūs net ir veiksmingos profilaktikos laikais. Pacientai ir jų artimieji taip pat turi išlikti sąmoningi ir atidūs, tai leistų anksti pastebėti simptomus.Raktažodžiai: Pneumocystis jirovecii, Pneumocystis pneumonija, inkstų transplanto recipientai, atvejo aprašymas.

BACKGROUND: Due to the increasing number of patients after kidney transplantation, elective and emergency surgery of transplanted patients is becoming a relevant challenge in clinical routine. The current data on complication rate of patients after kidney transplantation, which must undergo another elective or emergency abdominal surgery, is inhomogeneous. Therefore, the aim of our study was to evaluate the outcome of renal transplant patients undergoing abdominal and abdominal wall surgery.
METHODS: We performed an observational study of patients after kidney transplantation undergoing graft-unrelated abdominal surgery between 2005 and 2015. We randomly created a non-transplanted control for a case-matched controlled analysis. Primary endpoint was the comparison of complication rate. Secondary, a risk analysis of all patients was performed and differences in mortality, length of hospital stay and reoperation rates were calculated.
RESULTS: Overall 101 kidney transplanted patients were eligible for inclusion. 20 (19.8%) died after graft-unrelated surgery and 60 (59.4%) suffered from postoperative complications. Case-matched analysis could be performed for 84 out of these 101 patients. We found no significant difference in morbidity rate (58.3% vs. 45.2%, p = 0.090). Transplanted patients had, however, a significantly higher mortality (19% vs. 2.4%, p = 0.001), a longer hospital stay (28.2 vs. 16.9 days, p = 0.020) and a higher rate of re-operations (38.1% vs. 20.2%, p = 0.017). .
CONCLUSIONS: Patients after renal transplantation undergoing graft-unrelated abdominal surgery have a significantly increased mortality risk, are more frequently re-operated and have to stay significantly longer in hospital than non-transplanted patients.