Case Report
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World J Gastroenterol. Dec 28, 2014; 20(48): 18495-18502
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18495
Renal aspergillosis after liver transplantation: Clinical and imaging manifestations in two cases
Xiao-Chun Meng, Ting Jiang, Shu-Hong Yi, Pei-Yi Xie, Yue-Fei Guo, Li Quan, Jing Zhou, Kang-Shun Zhu, Hong Shan
Xiao-Chun Meng, Ting Jiang, Pei-Yi Xie, Yue-Fei Guo, Li Quan, Kang-Shun Zhu, Hong Shan, Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Shu-Hong Yi, Department of Organ Transplantation, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Jing Zhou, Department of Pathology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Meng XC, Jiang T, Yi SH, Zhu KS and Shan H designed this research; Meng XC, Jiang T, Xie PY, Guo YF, Quan L and Zhou J performed the research and analyzed the data; Meng XC, Jiang T, Zhu KS and Shan H wrote the paper.
Supported by Forty-third Batch of the Scientific Research Foundation for Returned Oversea Scholars from the Ministry of Education; National Natural Science Foundation of China, No. 81201090, No. 81371554, No. 81371655 and No. 81071206; Guangdong Natural Science Foundation, No. S2012010008367; and Guangdong Science and Technology Project, No. 2010B031600053
Correspondence to: Hong Shan, MD, PhD, Professor, Chief, Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. shanhong@mail.sysu.edu.cn
Telephone: +86-20-85253108 Fax: +86-20-85252616
Received: April 9, 2014
Revised: June 28, 2014
Accepted: July 22, 2014
Published online: December 28, 2014
Abstract

Renal aspergillosis (RAsp) is a rare complication in liver transplant (LT) recipients. Here we report RAsp in two LT recipients. In both patients, RAsp occurred more than 90 d after allogenetic orthotropic LT, and all the clinical findings were unspecific. RAsp involved unilateral kidney in Case one and bilateral kidneys in Case two. Both computed tomography (CT) and magnetic resonance imaging (MRI) revealed renal abscesses, with progressively enhanced walls and separations and unenhanced alveolate areas after contrast agent administration. On unenhanced CT images they showed inhomogeneous hypo-attenuation. On fat-suppressed T2-weighted images (T2WIs), the walls and separations of the abscesses showed slightly low signal intensity and the central parts of the lesions showed slightly high signal intensity. Both on CT and MRI, there were some hints of renal infarction or chronic ischemia. Both cases were treated by radical nephrectomy followed by adjuvant antifungal treatment. They all recovered well.

Keywords: Liver transplantation, Kidney, Aspergillus infection, Computed tomography, Magnetic resonance imaging, Treatment

Core tip: This paper reports renal aspergillosis (RAsp) in two liver transplant (LT) recipients more than 90 d after allogenetic orthotropic LT, and describes the computed tomography and magnetic resonance imaging manifestations of renal lesions, including the abscesses and surroundings. The findings in this report may help improve the diagnosis of RAsp. After receiving radical nephrectomy followed by adjuvant antifungal treatment, both patients recovered well without mortality from RAsp.