Aureobasidium Pullulans Sepsis Developing in Patient, Who Received Kidney Transplantation in China

Chung, Jong Ju; Kwon, Ki Hwan; Kim, Chang Ki; Lim, Chi Young; Huh, Kyu Ha; Yong, Dong Ean; Kim, Soon Il; Kim, Yu Seun; Park, Kiil

Abstract

Aureobasidium Pullulans (AP) is a fungus known as a "black fungus" characterized by production of melanin pigment. It is infected mainly by subcutaneous pathway, but causes a very rare disease in human. There was a very few report of AP infection in human all around the world and no report in Korea, yet. We reported the first Korean case of AP sepsis patient who received the second kidney transplantation in China. The patient was a 61-year old male who underwent the first kidney transplantation at Severance Hospital in July 1992 and had experienced chronic renal graft dysfunction for the last several years. He went to China and underwent the 2nd kidney transplantation from acute brain-injury donor on December 31, 2002. He discharged and came back to Korea at POD #14 and admitted to our department. At admission, there was no specific symptom or sign of infection and the function of allograft kidney was good with serum creatinine of 1.2 mg/dL. He was on tacrolimus 4 mg bid, deltacortef 10mg bid and MMF 1.0 gm bid. During the hospitalization, the dosage of tacrolimus was controlled by adjusting serum tacrolimus level around 10~15 ng/mL, and reduced the dosage of deltacortef to 5 mg bid and MMF to 500 mg bid. Since Zenapax was already administered during the hospitalization in China, we added additional injection of Zenapax twice with 2 weeks interval. On POD #22, he developed skin rash and edema compatible to cellulites on the intravenous puncture site of left upper arm during his hospital stay in China. MMF was stopped and broad spectrum antibiotic therapy was started immediately. On POD #23, he developed acute myocardiac infarction and he undertook PTCA with arterial stent insertion. He was transported to intensive care unit due to acute respiratory failure on POD #27, and the left arm color was changed to black on POD #30. The empirical intravenous amphotericin therapy was started at POD #35, but the patientdied due to multiple organ failure caused by fungal sepsis. After his death, we received positive culture report of AP from his blood and skin lesion specimens collected on POD #29 and 35.