Uncommon cause of fever in a pediatric kidney transplant recipient: Questions

Excerpt

A 15-year-old boy received a living related pre-emptive renal transplant from his mother (native kidney disease being obstructive uropathy secondary to untreated congenital posterior urethral valves). The immunosuppression regimen consisted of the induction agent basiliximab and maintenance immunosuppression with the therapeutic combination tacrolimus + mycophenolate mofetil (MMF) + prednisolone. His baseline serum creatinine after renal transplant was 1 mg/dl. Ten months later, acute graft dysfunction ensued, and creatinine levels reached 9.8 mg/dl due to non-compliance with the medications, which necessitated hemodialysis. Kidney biopsy revealed acute cellular allograft rejection (Banff classification type IIA). The patient received three doses of pulse methylprednisolone and antithymocyte globulin (6 mg/kg), and the creatinine level dropped to 2.4 mg/dl. He was discharged on a combined therapeutic regimen of tacrolimus (levels: 6–8 ng/ml) + prednisolone + MMF. …