Resumen
Los inmunosupresores en pacientes trasplantados los hace susceptibles a microorganismos oportunistas que pueden causar fiebre.
Nosotros comunicamos el caso de un paciente masculino, hipertenso, creatinina sérica (CS) 5,8 mg/dl, riñones disminuidos, en hemodiálisis durante 5 meses, que recibe trasplante de hermano e inicia prednisona, ciclosporina, azatioprina y antihipertensivos.
A la semana la CS es 1,8 mg/dl. Diez años después la CS es 2,7 mg/dl, se omite ciclosporina, iniciándose rapamicina 2 mg/día; 14 días después presenta fiebre.
Fue hospitalizado como síndrome febril prolongado, permaneció febril aproximadamente 3 meses, cultivos y serología negativos, Rx y TAC normales, sin derrame pericárdico.
La fiebre persistió con antibioticoterapia de amplio espectro.
Se omitió rapamicina,desapareció la fi ebre y permaneció afebril 2 meses. Como prueba se administra rapamicina, reapareciendo la fi ebre 48 horas después.
Se suspendió y desapareció.
En este caso concluimos que la rapamicina puede causar síndrome febril prolongado en pacientes con transplante renal, como único efecto adverso del medicamento.
Abstract
The immunomodulators in transplanted patients makes them susceptible to opportunistic microorganisms that can cause fever.
We report a male patient case, with hypertension, serum creatinine(SC) of 5.8 mg/dl, and kidneys diminished in size.
The patient had been in hemodialysis during 5 months when he received a transplant from a brother and initiate a treatment with prednisone,
ciclosporin, azathioprin and antihypertensive medicaments.
After 1 week from the transplant the SC levels were of 1.8 mg/dl.
10 years later the SC is 2,7 mg/dl, and ciclosporin A was omitted,starting rapamicin 2 mg per day. After 14 days from initiating the treatment the patient presented fever and was hospitalized with prolonged fever syndrome.
The febrile state persisted during 3 months with negative cultures and serology, normal Rx and TAC, without pericardial effusion.
Fever still persisted with intravenous antibiotic therapy.
Rapamicin was omitted and the patient stayed without fever during 2 months. Rapamicin was started once again as a diagnostic prove reappearing the fever after 48 hours. It was suspended and it disappeared again. We concluded in this case, that rapamicin could be the cause of prolonged fever syndrome in patients with kidney transplant as unique adverse effect of this medicament.
