Case Report: Isospora infection on intestinal transplanted patient.

FUXMAN C. ; GRUZ F; ERREA A; CABANNE A; TOKUMOTO, M; RUMBO M; GONDOLESI G.

Santa Mónica, CA, USA

Simposio; Xth International Small Bowel Transplantation Symposium; 2007

Intestinal transplant (ITx) recipients are at risk for opportunistic infections.Isospora belli´s chronic diarrhea is prevalent in immunosuppressed hosts, mainly in HIV-AIDS patients. Only one case of Isospora infection in a kidney transplanted patient has been reported in the literature. Aim: to report the first case of Isospora infection after ITx. Results: An isolated ITx was performed on a 23-year old patient with ultra short gut syndrome secondary to post-operative complications of an appendicectomy. The patient was discharged home on post-operative day 28 without complications. Follow-up intestinal biopsies showed no signs of rejection but a persistent non-specific inflammation with granulocyte infiltration was observed since post-ITx day 35 with no-other clinical signs. Calprotectin levels in intestinal content showed a marked increase starting at post-ITx day 25. At day 80 the patient was hospitalized with increased ostomy output, dehydration and hypokalemia. Endoscopy revealed duodenal ulcerations and mucosal congestion. On day 84 Isospora infection was diagnosed by detection of the oocysts in stool by optical microscopy. Treatment with TMS was initiated. In a few days gastrointestinal symptoms disappeared. Developmental stages of Isospora could not be detected in biopsies taken at diagnosis or in a retrospective analysis done on every intestinal biopsy obtained since the ITx operation. Both, donor and recipient, came from the north of Argentina, country-regionland, where infection with parasites of the Coccidia group is prevalent. Parasitologyc pre-transplant exam was negative and the patient did not returned to his State after ITx. However, he may have acquired the parasites from infected contacts.Conclusions: this case outlines the need of including a fresh parasitologyc exam for coccidial detection as part of the diagnostic algorithm of intestinal donors and cases of post-transplant diarrhea in endemic regions.