Rare diagnostics of infective endocarditis after kidney transplantation

Česká verzia

Authors: Ivana Dedinská ¹; Petra Skalová ¹; Michal Mokáň ²; Katarína Martiaková ²; Denisa Osinová ³; Miroslav Pindura ¹; Blažej Palkoci ¹; Marián Vojtko ⁴; Janka Hubová ⁴; Denisa Kadlecová ⁴; Ivona Lendová ⁴; Radovan Zacharovský ⁵; Filip Pekar ⁵; Lucia Kaliská ⁶
Authors place of work: Chirurgická klinika a transplantačné centrum JLF UK a UN Martin, Slovenská republika ¹; I. Interná klinika JLF UK a UN Martin, Slovenská republika ²; Klinika anestéziológie a intenzívnej medicíny JLF UK a UN Martin, Slovenská republika ³; Dialyzačné stredisko B. Braun Avitum, s. r. o., Trstená, Slovenská republika ⁴; Stredoslovenský ústav srdcových a cievnych chorôb, a. s., Banská Bystrica, Slovenská republika ⁵; Agel diagnostic, a. s., Banská Bystrica, Slovenská republika ⁶
Published in the journal: Vnitř Lék 2016; 62(1): 48-51
Category: Case Reports

Summary

Introduction:
Infective endocarditis in a patient after kidney transplantation is a serious infective complication which increases the risk of loss of the graft and also the mortality of patients. The most important predisposing factor is the immunosuppressive therapy – mainly induction immunosuppression.

Material and case description:
250 patients underwent kidney transplantation throughout the period of 12 years in the Transplant Center Martin. This set of patients included 5 patients (2 %) after heart valve replacement. We present the case of a patient after kidney transplantation with development of endocarditis of the bioprosthesis of the aortic valve one month after successful kidney transplantation. Diagnostics of endocarditis by standard procedures (examination by transthoracic echocardiogram, transesophageal echocardiography, hemocultures) was unsuccessful. We rarely diagnosed endocarditis only by PET-CT examination with a consequent change of the antibiotic treatment and successful managing of this post-transplant complication.

Conclusion:
Endocarditis after kidney transplantation is a serious complication which significantly worsens the mortality of patients. The risk of development of infective endocarditis after transplantation is also increased by induction, mainly by antithymocyte globulin. Diagnostics only by PET-CT examination is rare; however, in this case it fundamentally changed the approach to the patient and led to a successful treatment.

Key words:
endocarditis – induction – kidney transplantation – PET-CT

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