Group A Streptococcal bacteraemia and necrotizing faciitis in a renal transplant patient: a case for intravenous immunoglobulin therapy

Extract

Introduction

Acute infectious diseases in immunocompromised patients are potentially life threatening. This report deals with a Gram‐positive, Gp. A streptococcal (Streptococcus pyogenes) (GAS) bacteraemia, complicated by necrotizing fasciitis, in a renal transplant patient. Conventional antibiotic therapy together with intravenous (i.v.) gammaglobulin led to a complete recovery, without having to resort to debilitating surgical debridement.

Case

A 37‐year‐old female was admitted with a 12‐h history of fever together with epigastric and right shoulder pain.

Relevant past history included end‐stage renal failure, secondary to diffuse proliferative glomerulonephritis complicating systemic lupus erythematosis. Peritoneal dialysis had been carried out for 6 months until August 1998 when she received a cadaver‐donor renal transplant. ‘Triple therapy’ (prednisone, azathioprine, and tacrolimus) was initiated. At 3 months post‐transplant renal function was good (serum creatinine: 1.2 mg/dl). In January 2001, renal function deteriorated (serum creatinine: 2.3 mg/dl). A closed biopsy of the transplanted kidney revealed acute cellular rejection. I.v. methylprednisolone (500 mg) was given on 3 consecutive days. During those 3 days numerous attempts were made to cannulate veins for the methylprednisolone therapy. On the day after the last ‘bolus’ the patient was admitted.