复旦大学：《传染病学 Infectious Disease》课程教学资源（MBBS）教案案例（英文）Cerebropulmonary Nodules in a Renal Allograft Recipient

Cerebropulmonary Nodules in a Renal Allograft Recipient Zhao Huazhen Clin Infect Dis. 2016: 62

Zhao Huazhen Clin Infect Dis. 2016:62

General information 口A38-year- old male a presented with fever and chills for 2 weeks

General information p A 38-year-old male p presented with fever and chills for 2 weeks

Past medical history a ABO-compatible renal transplant 9 months prior, steroids, FK506, and mycophenolate mofetil(MMF) for immunosuppression and TMP-SMX for prophylaxIs a a biopsy-proven borderline t-cell-mediated rejection in the second post-transplant week(PtW), a single dose(1.5 mg/kg of antithymocyte globulin n CMV colitis at the 4th ptw, subsequent 3-week therapy with ganciclovir

Past medical history p ABO-compa<ble renal transplant 9 months prior, steroids, FK506, and mycophenolate mofe<l (MMF) for immunosuppression and TMP-SMX for prophylaxis p a biopsy-proven borderline T-cell-mediated rejec<on in the second post-transplant week (PTW) , a single dose (1.5 mg/kg) of an<thymocyte globulin p CMV coli<s at the 4th PTW, subsequent 3-week therapy with ganciclovir

Past medical history a Persistent leukopenia and previous cmv disease warranted stopping MMF after the 8n PTW At the 3otn ptW, the patient stopped his TMP-SMX prophylaxis owing to poor gastrointestinal tolerance

Past medical history p Persistent leukopenia and previous CMV disease warranted stopping MMF aXer the 8th PTW p At the 30th PTW, the pa<ent stopped his TMP-SMX prophylaxis owing to poor gastrointes<nal tolerance

Present history Presented with fever and chills for two weeks aAt admission, stage 2 hypertension, fungal balanoposthitis serum creatinine level of 1. 8 mg/dL, and trough FK506 level of 12. 31 ng/mL; blood PCr positive for CMv (65 000 copies/mL), and urine culture grew multidrug-resistant Escherichia coli iNtravenous meropenem, colistimethate sodium ganciclovir, and a stat dose of oral fluconazole; the daily dose of fk506 reduced

Present history Presented with fever and chills for two weeks pAt admission, stage 2 hypertension, fungal balanoposthi<s, serum crea<nine level of 1.8 mg/dL, and trough FK506 level of 12.31 ng/mL; blood PCR posi<ve for CMV (65 000 copies/mL), and urine culture grew mul<drug-resistant Escherichia coli. pIntravenous meropenem, colis<methate sodium, ganciclovir, and a stat dose of oral fluconazole; the daily dose of FK506 reduced

Present history a two days after admission sudden-onset faciobrachial monoparesis, seizures, and progressively deteriorating sensorium a Brain mri and thoracic ct a Lab findings: serum cryptococcal antigen and pcr of bronchoalveolar lavage fluid for tuberculosis and malignant cells all negative

Present history p Two days aXer admission, sudden-onset faciobrachial monoparesis, seizures, and progressively deteriora<ng sensorium. p Brain MRI and thoracic CT p Lab findings: serum cryptococcal an<gen, and PCR of bronchoalveolar lavage fluid for tuberculosis and malignant cells all nega<ve

Image finding-cranial MRI 2 day 10 day T2WI shows 2 hyperintense lesions in T2Wi shows multiple isointense the right frontal lobe with lesions with perilesional edema in perilesional edema both cerebral hemispheres

Image finding-cranial MRI T2WI shows 2 hyperintense lesions in the right frontal lobe with perilesional edema. T2WI shows multiple isointense lesions with perilesional edema in both cerebral hemispheres. 2 day 10 day

Image finding-thoracic CT CT shows multiple nodular areas of consolidation in both lungs. the lesion in the right upper lobe is showing air bronchogram

Image finding-thoracic CT 2 day 10 day CT shows multiple nodular areas of consolidation in both lungs. The lesion in the right upper lobe is showing air bronchogram

summary 口A38year- old male a renal transplant 9 months prior, in use of steroids and FK506, MMF and TMP-SMX stopped a fever and chills for 2 weeks, sudden -onset faciobrachial monoparesis seizures and progressively deteriorating sensorium a Brain mRi and thoracic ct showed multiple lesions a Negative findings for cryptococcus, tb and malignant cells 口 Poorly react to meropenem, colistimethate sodium(多粘菌素), ganciclovir, and oral fluconazole

summary p A 38-year-old male p renal transplant 9 months prior, in use of steroids and FK506, MMF and TMP-SMX stopped p fever and chills for 2 weeks, sudden-onset faciobrachial monoparesis, seizures, and progressively deteriora<ng sensorium. p Brain MRI and thoracic CT showed mul<ple lesions p Nega<ve findings for cryptococcus, TB and malignant cells p Poorly react to meropenem, colis<methate sodium(多粘菌素), ganciclovir, and oral fluconazole

New findings 命吸 Direct smear with modified ziehl-neelsen stain demonstrating branching and beading rods Disseminated nocardiosis

New findings Direct smear with modified Ziehl–Neelsen stain demonstrating branching and beading rods Disseminated nocardiosis