Fatal case of invasive aspergillosis and cytomegalovirus coinfection after kidney transplantation inside the Eurotransplant Senior Program

While the number of renal transplantations steadily increases, tremendous efforts and progresses have been made to prevent graft rejection. However, in return for increased and potent immunosuppressive therapies, a higher rate of infectious complications can be seen. Diagnosis of infection may be difficult in the immunosuppressed posttransplant patient, especially if subclinical infections occur. This is especially true for cytomegalovirus (CMV) co-infections, which are known for their immunosuppressive effect. Cases of simultaneous Aspergillus pneumonia and CMV pneumonitis have rarely been documented. We report about a 66-year-old man with a CMV-associated invasive aspergillosis infection after a kidney transplantation, who died because of a consecutive septic multiple organ failure due to aspergillosis pneumonia, myocarditis and necrotic nephritis of the transplanted kidney. The diagnosis of coexisting infections proved to be difficult and thus delayed the initiation of appropriate antimicrobial-antifungal treatment. A high degree of suspicion is therefore recommended in immunosuppressed posttransplant patients with unexplained subclinical course.