COMPLICATIONS - INFECTIONS

M. Sereinigg¹, P. Stiegler¹, S. Schaffellner¹, F. Iberer¹, D. Kniepeiss¹, T. Valentin², M. Schweiger¹, D. Wagner¹, A. Puntschart¹, R. Krause², K. Tscheliessnigg^1
1Department For Surgery, Division For Transplantation Surgery, Medical University Graz, Graz/AUSTRIA, ²Department Of Internat Medicine, Division For Pulmonology, Medical University Graz, Graz/AUSTRIA

Body: Introduction A 47-year-old patient suffering from Type I diabetes for sixteen years underwent combined pancreas-kidney transplantation (PKTX) 8 years ago. The cell and organ function has been stable since the transplantation (Creatinin 1,72mg/dl, GFR: 45,71 ml/min, C-Peptid: 3,7 ng/ml) under immunosuppression consist of Tacrolimus, Sirolimus and MMF. Methods Six and a half years after the PKTX, the patient presented with massive ascites (22 liters in 5 days). Ascites and blood analysis only revealed eosinophilia all other parameters tested were within normal limits. However, further infectiological analysis, did not show any signs of infection with parasites. The only symptoms except ascitis, the patient suffered from, were recurrent nausea and vomiting. Furthermore, multiple gastroscopies were performed due to nausea and vomiting but did not show any pathologies. Several CT-scans as well as abdominal sonography were performed, but the pathophysiology of the sudden onset ascites could not be explained. Screening for malignancies was negative, laboratory values showed an increased GGT value (92 U/L) but there were no signs of liver dysfunction or renal impairment. Results Infectiological screening did not show any signs of infection, neither in the serum nor in the ascites during the whole time span. However, eighteen months after onset of the ascites, serology for toxocara in serum was positive. Toxocara canis and cati are not only ubiquitously distributed parasites of dogs, foxs and cats but they may also infect human beings. They cause a great variety of symptoms (fever, asthma bronchiale, epileptic fits etc.) and also several diseases of childs (e.g. larva migrans visceralis, occular toxocariasis). The human being is the wrong host because the reproduction of the larves can not be completed, but the larves are able to survive in human beings for years. The patient was treated with albendazol 400mg twice a day for 10 days. Finally, after this period of care, no signs of eosinophilia in the serum and the abdominal sonography were found and he did not show any signs of recurrence of ascites any longer.

Disclosure: All authors have declared no conflicts of interest.