The Korean Journal of Medicine

  • 제86권5호
  • /
  • Pages.627-631
  • /
  • 2014
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

신이식 후 거대세포바이러스 감염을 동반한 감염성 심내막염 1예

A Case of Infective Endocarditis with Cytomegalovirus Infection after Kidney Transplantation

  • 홍문기 (중앙대학교 의과대학 내과학교실) ;
  • 김도형 (중앙대학교 의과대학 내과학교실) ;
  • 김채림 (중앙대학교 의과대학 내과학교실) ;
  • 홍준화 (중앙대학교 의과대학 흉부외과학교실) ;
  • 김미경 (중앙대학교 의과대학 병리학교실) ;
  • 김수현 (중앙대학교 의과대학 내과학교실)
  • Hong, Moon-Ki (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Do-Hyoung (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Chae-Rim (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Hong, Joonhwa (Department of Thoracic and Cardiovascular Surgery, Chung-Ang University College of Medicine) ;
  • Kim, Mi-Kyung (Department of Pathology, Chung-Ang University College of Medicine) ;
  • Kim, Su-Hyun (Department of Internal Medicine, Chung-Ang University College of Medicine)
  • 투고 : 2013.06.08
  • 심사 : 2013.09.09
  • 발행 : 2014.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

저자들은 신장이식 후 면역억제제를 지속적으로 사용하는 환자에서 거대세포바이러스 감염과 함께 병발한 아스페르길루스 심내막염 1예를 경험하였다. 최근 면역억제제 사용이 증가하면서 면역 저하와 함께 기회 감염의 빈도도 증가하고 있으며 특히 거대세포바이러스 감염을 동반할 경우 면역 억제의 정도가 심해지면서 그 빈도가 더욱 증가할 것으로 생각된다. 특히 아스페르길루스와 같은 진균 감염의 경우 혈액배양 검사에서 동정될 확률이 낮고 치료 시기를 놓칠 경우 사망률이 높음으로 기회 감염에 대한 혈청학적 검사가 진단 및 치료에 중요한 단서가 될 수 있다.

Advances in immunosuppressive therapy have increased the survival of kidney transplant recipients, yet suppression of the immune system after transplantation can promote infectious complications. Cytomegalovirus (CMV) infection remains one of the most important complications following kidney transplantation and it is a risk factor for developing superinfections with other organisms. Aspergillus endocarditis is a rare life-threatening complication in kidney transplantation. Coinfection of CMV and Aspergillus endocarditis is rare worldwide and has not been reported in Korea. We report a case of Aspergillus endocarditis that developed in a patient with CMV infection after kidney transplantation. His clinical condition did not improve despite mitral valve replacement and empirical antibiotic treatment, but he was eventually treated successfully with antifungal agents for 6 weeks.

키워드

과제정보

연구 과제 주관 기관 : National Research Foundation of Korea (NRF)

참고문헌

  1. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357:2601-2614. https://doi.org/10.1056/NEJMra064928
  2. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345:1318-1330. https://doi.org/10.1056/NEJMra010082
  3. Hong KW, Lee JA, Park HW, et al. A case of infective endocarditis caused by Aspergillus fumigatus in a liver transplant recipient. Korean J Med 2008;75:115-118.
  4. Minari A, Husni R, Avery RK, et al. The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants. Transpl infect Dis 2002;4:195-200. https://doi.org/10.1034/j.1399-3062.2002.t01-2-02002.x
  5. Gupta KL. Fungal infections and the kidney. Indian J Nephrol 2001;11:147-154.
  6. Einollahi B, Lessan-Pezeshki M, Pourfarziani V, et al. Does CMV infection increase the incidence of infective endocarditis following kidney transplantation? Ann Transplant 2009;14:32-37.
  7. Houpikian P, Raoult D. Blood culture-negative endocarditis in a reference center: etiologic diagnosis of 348 cases. Medicine (Baltimore) 2005;84:162-173. https://doi.org/10.1097/01.md.0000165658.82869.17
  8. Gumbo T, Taege AJ, Mawhorter S, et al. Aspergillus valve endocarditis in patients without prior cardiac surgery. Medicine (Baltimore) 2000;79:261-268. https://doi.org/10.1097/00005792-200007000-00007
  9. Paterson DL, Dominguez EA, Chang FY, Snydman DR, Singh N. Infective endocarditis in solid organ transplant recipients. Clin Infect Dis 1998;26:689-694. https://doi.org/10.1086/514590
  10. Venkataramanan R, Zang S, Gayowski T, Singh N. Voriconazole inhibition of the metabolism of tacrolimus in a liver transplant recipient and in human liver microsomes. Antimicrob Agents Chemother 2002;46:3091-3093. https://doi.org/10.1128/AAC.46.9.3091-3093.2002