Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1155-1159
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1155
Renal aspergillosis in a liver transplant patient: A case report and review of literature
Brigita Smolovic, Batric Vukcevic, Damir Muhovic, Marina Ratkovic
Brigita Smolovic, Batric Vukcevic, Marina Ratkovic, Faculty of Medicine, University of Montenegro, Podgorica 20000, Montenegro
Brigita Smolovic, Damir Muhovic, Department of Gastroenterohepatology, Clinical Center of Montenegro, Podgorica 20000, Montenegro
Marina Ratkovic, Department of Nephrology and Hemodialysis, Clinical Center of Montenegro, Podgorica 20000, Montenegro
Author contributions: Smolovic B collected the patient’s clinical data and wrote the paper; Vukcevic B and Muhovic D designed the report and co-wrote the paper; Ratkovic M analyzed the data and designed the report.
Informed consent statement: Consent was obtained from the patient and his/her relatives for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The guidelines of the CARE checklist (2016) have been adopted during the writing of this paper. The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Batric Vukcevic, MD, Teaching Assistant, Faculty of Medicine, University of Montenegro, Ljubljanska No. 1, Podgorica 20000, Montenegro. batricvukcevic@gmail.com
Telephone: +382-69-799114
Received: October 7, 2018
Peer-review started: October 7, 2018
First decision: November 8, 2018
Revised: November 10, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Processing time: 78 Days and 7.9 Hours
Abstract
BACKGROUND

Aspergillosis is a frequent invasive fungal infection in liver recipients (affecting 1%-9.2% of all patients), second only to candidiasis. Significant risk factors for invasive aspergillosis in liver recipients include corticosteroid therapy, neutropenia, T-cell dysfunction, renal failure and requirement for renal replacement therapy. Aspergillus infection usually affects the lungs of liver recipients, with hematogenous dissemination occurring in 50%-60% of cases. Renal involvement is rare and is considered to occur in 0.4% of all cases of invasive aspergillosis.

CASE SUMMARY

This paper describes a case of a liver recipient presenting with a newly formed renal mass a year after liver transplantation. The patient underwent liver transplantation due to alcoholic liver cirrhosis, with preoperative corticosteroid therapy and postoperative immunosuppressants (tacrolimus and mycophenolate mofetil). His 1-year follow-up was uneventful, with a satisfying graft function and lack of any symptoms. During a routine follow-up abdominal ultrasound, he was diagnosed with a renal tumor. The renal imaging findings were inconclusive (with a differential diagnosis to renal cell carcinoma), while the computed tomography (CT) of the chest showed scar tissue in the lungs suggestive of previous inflammation. The patient underwent radical nephrectomy, with histopathological analysis showing renal aspergilloma, yielding postoperative treatment with voriconazole. His follow up was uneventful, and the chest CT did not show any change in pulmonary lesions. This case illustrates the possibility of aspergillosis affecting the lungs of liver recipients, subsequently affecting the kidney and forming an aspergilloma.

CONCLUSION

Clinicians should be aware of aspergilloma mimicking solid organ tumors in organ recipients.

Keywords: Aspergillosis; Immunosuppression; Liver transplantation; Nephrectomy; Renal tumor; Case report

Core tip: Renal aspergilloma should be suspected in cases of newly formed renal mass in immunosuppressed patients (e.g., after organ transplantation). Imaging findings in renal aspergilloma are frequently inconclusive, with a possible differential diagnosis to renal cell carcinoma or other tumors. Reduction of immunosuppression and antifungal therapy is required in the treatment of invasive aspergillosis. Surgical treatment should be considered in cases of renal aspergillosis.