Yellow fever disease in a renal transplant recipient: Case report and literature review. Issue 5 (13th August 2019)

• Record Type: Journal Article
• Authors: de Sousa, Marcos Vinicius; Zollner, Ricardo de Lima; Stucchi, Raquel Silveira Bello; Boin, Ilka de Fátima Santana Ferreira; de Ataide, Elaine Cristina; Mazzali, Marilda
• Is Part Of: Transplant infectious disease. Volume 21:Issue 5(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-08-13
• Subjects: antibody‐producing cells -- arbovirus infections -- graft rejection -- HLA antigens -- immunosuppression -- plasmapheresis; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13151
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Yellow fever (YF) is a viral disease, with clinical presentation among immunosuppressed patients not fully understood. YF vaccination (YFV), a live vaccine, is contraindicated in patients receiving immunosuppressive treatment due to the risk of developing the disease after vaccination. We report a case of a 50‐year‐old male recipient who presented wild‐type YF five years after a deceased donor kidney transplant. He lived in a YF endemic area and inadvertently received YFV. One day after YFV, the patient presented nausea, vomiting, fever, diarrhea, polyarthralgia, thrombocytopenia, and increased levels of liver function enzymes. The serological test was compatible with YF disease, and quantitative viral load confirmed the diagnosis of wild‐type YF. The patient received supportive care for twelve days, with hospital discharge in good clinical condition and stable renal function. One month after discharge, the patient developed de novo donor‐specific anti‐HLA antibodies (DSA) and histological evidence of endothelial lesion, with a diagnosis of acute antibody‐mediated rejection (AMR), treated with plasmapheresis and human IVIg therapy. Six months after therapy, he presented normal renal function with a reduction of DSA MFI. In the reported case, we observed a clinical wild‐type YF diagnosed even after YF vaccine administration, with good clinical outcome. De novo DSA and AMR occurred after the recovering of disease, with an adequate response to therapy and preserved allograft function. We reviewed the published literature on YF and YFV in solid organ transplantation.