S. Dražilová, J. Kinčeková, Ľ. Beňa, M. Zachar, M. Švajdler, P. Zavacký and P. Jarčuška
52-years old man years following the kidney transplantation from deceased donor was admitted to the hospital with fever and progressive abdominal pain. The patient was diagnosed with chronic hepatitis C seven years before admission. Graft function in posttransplant period was stable and optimal, the patient was treated with standard maintenance immunosupresive protocol (cyclosporine A, mycophenolate mofetil and low-dose prednison), metylprednisolon bolus therapy (1 g/m2 body surface area), was administered two months prior to admission due to creeping creatinine (suspection of acute rejection was not confirmed by biopsy). Empiric antibiotic treatment due to febrile status was ineffective. Abdominal ultrasound and computer tomography (CT) scan revealed three tumorous lesions in the liver, radical surgical intervention was not executable. Histological examination of the tissue from the lesions demostrated alveolar echinococcosis, serology for Echinoccocus multilocularis was positive. Long-term treatment by mebendazol 200 mg twice daily led to disappearance of the clinical symptoms, but after the therapy cessasion patient was again hospitalized with fever and progression of cystic lesions in CT scan. Following the mebendazol therapy reinstalation the clinical course of echinococcosis was improved and remained stable, transplant kidney failure occurred due to progression of interstitial fibrosis/tubular atrophy and chronic haemodialysis was initiated one year later.
S. Dražilová, J. Kinčeková, Ľ. Beňa, M. Zachar, M. Švajdler, A. Königová, M. Janičko and P. Jarčuška
We present a case of 53 years old patient with transplanted kidney, chronic hepatitis C and alveolar echinococcosis who was treated with pegylated interferon α which resulted in regression and calcification of Echinococcus multilocularis loculi. Patient had been diagnosed with chronic hepatitis C two years after kidney transplantation. Hepatitis was left untreated because of immunosuppressive treatment and satisfactory graft function. Nine years after transplantation the patient was diagnosed with alveolar echinococcosis and treated with mebendazole 2 × 200 mg daily for 6 months. Cessation of temporary treatment resulted in echinococcosis progression with appearance of secondary loculi and a small ascites after which mebendazole was restarted. Ten years after transplantation, kidney graft failure occurred and the patient was started on hemodialysis in conjunction with pegylated-interferon alpha 2a for treatment of chronic viral hepatitis C. Complete early viral response was observed 3 months after therapy initiation while a follow-up CT scan after 4 months did not document any changes in the number or size of E. multilocularis loculi. A completed course of antiviral therapy resulted in sustained viral response while a subsequent second follow-up CT scan 6 months after cessation of antiviral therapy documented regression and calcification of main E. multilocularis loculi along with resolution of secondary loculi and ascites.