PMID- 32812781
OWN - NLM
STAT- MEDLINE
DCOM- 20210225
LR  - 20210225
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 87
IP  - 1
DP  - 2021 Jan
TI  - Recurrent Postoperative Toxic Shock Syndrome in a Living Kidney Transplant 
      Recipient.
PG  - 89-91
LID - 10.1177/0003134820945217 [doi]
AB  - Recurrent toxic shock syndrome (TSS) is uncommon. A certain level of clinical 
      suspicion is indicated with a complex sepsis presentation in the postoperative 
      kidney transplant patient. We present a case of presumed recurrent postoperative 
      TSS in a living kidney transplant recipient. The patient was a 19-year-old 
      Caucasian female with a 4-year prior single episode of toxin-mediated sepsis and 
      chronic kidney disease (CKD) secondary to autosomal recessive Alport's syndrome 
      (confirmed via renal biopsy and genetic testing). She received a human leukocyte 
      antigen (HLA) 2A 2B 1DR MM, CMV -D/-R kidney from her 21-year-old friend. The 
      patient received Campath and IV steroid induction after total cold ischemic time 
      of 170 minutes with 40 minutes of revascularization. On postoperative day (POD) 
      5, she required re-exploration with reimplantation and stenting of the 
      transplanted ureter. The patient subsequently spiked a fever of 101.6 degrees  with a 
      generalized rash prompting collection of blood cultures which demonstrated no 
      growth. Infectious Disease was consulted due to persistent fevers despite IV 
      antibiotics. On POD 12, the patient returned to the operating room (OR) for 
      evacuation of hematoma after decline in Hgb to 5.8 and CT confirmed perinephric 
      hematomas. Kidney biopsy showed no rejection and donor specific antibodies (DSAs) 
      were unremarkable. The patient underwent 1 treatment of empiric plasmapheresis 
      for possible non-HLA antibodies followed by initiation of clindamycin. The 
      patient's condition improved, and she was discharged home with a normal 
      creatinine. Recurrent TSS is rare but should be added to the differential 
      diagnoses of immuno-compromised patients undergoing kidney transplantation with a 
      history of prior toxin-mediated sepsis.
FAU - Aslam, Sadaf
AU  - Aslam S
AD  - Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
FAU - Buggs, Jacentha
AU  - Buggs J
AD  - Department of Transplant Surgery, Tampa General Medical Group, Tampa, FL, USA.
FAU - Rogers, Ebonie
AU  - Rogers E
AD  - 7829Office of Clinical Research, Tampa General Hospital, Tampa, FL, USA.
FAU - Bowers, Victor
AU  - Bowers V
AD  - Department of Transplant Surgery, Tampa General Medical Group, Tampa, FL, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20200819
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Female
MH  - Humans
MH  - Kidney Transplantation/*adverse effects
MH  - Nephritis, Hereditary/complications/*surgery
MH  - Plasmapheresis
MH  - Postoperative Complications/diagnosis/*etiology/therapy
MH  - Recurrence
MH  - Renal Insufficiency, Chronic/etiology/*surgery
MH  - Shock, Septic/diagnosis/*etiology/*therapy
MH  - Young Adult
OTO - NOTNLM
OT  - kidney transplant
OT  - recurrent
OT  - toxic shock syndrome
EDAT- 2020/08/20 06:00
MHDA- 2021/02/26 06:00
CRDT- 2020/08/20 06:00
PHST- 2020/08/20 06:00 [pubmed]
PHST- 2021/02/26 06:00 [medline]
PHST- 2020/08/20 06:00 [entrez]
AID - 10.1177/0003134820945217 [doi]
PST - ppublish
SO  - Am Surg. 2021 Jan;87(1):89-91. doi: 10.1177/0003134820945217. Epub 2020 Aug 19.