Cellulitis in a post-kidney transplant patient--more than meets the eye

Abstract

A 47-year-old woman was hospitalized due to fever, shortness of breath and anterior thoracic chest pain. She had undergone an uneventful cadaveric kidney transplantation 2 months prior to her referral to hospital. The patient's past medical history was significant for several years of hemodialysis for an undiagnosed end-stage renal disease, hypertension and hyperlipidemia. Her medications included tacrolimus, prednisone, mycophenolate mofetil, valgancyclovir, sulfamethoxazole/trimethrprim, amlodipine, doxazocin, metoprolol, simvastatin, papaverine and lansoprazole. On physical examination she had decreased airflow over her left lower lung. Chest radiography demonstrated a consolidation in the left lower lung field and the right upper lobe (Figure 1A). A computer tomography scan showed multiple lesions in both lungs, some of them with cavitary centers. The patient had no productive cough and did not produce sputum for analysis and cultures. Echocardiography was normal. The patient was treated with oral azithromycin and intravenous cefuroxime antibiotics. Within 2 days, the fever and shortness of breath abated and the patient was discharged. Given the severity of the imaging findings, a 3-week course of intravenous ceftriaxone antibiotics was recommended. However, the patient stopped this treatment and follow-up after 10 days. Figure 1. Chest radiography with a right …