Background

Common complications following kidney transplant include infection, rejection, and malignancy. Multiple masses in a transplanted kidney raise suspicion for malignancy.

Case Presentation

A 20-year-old female with chronic kidney disease stage 3 T presented with graft tenderness, acute kidney injury, and heterogeneous masses in her transplanted kidney visualized via ultrasound. She was inadequately treated for chlamydia 1 month prior and retested positive upon admission. Initial workup revealed anemia, hyperglycemia, hyperuricemia, and elevated lactate dehydrogenase. Magnetic resonance imaging revealed complex masses of varying sizes in the transplanted kidney. Biopsy grew Streptococcus agalactiae, informing the diagnosis of multiple perinephric abscesses. Additional evaluations for infectious etiology were unremarkable. Her perinephric abscesses resolved with several months of antibiotics.

Conclusions

Even without a clear source, serious infections may develop in kidney transplant patients who otherwise have concern for malignancy. Chlamydial infections may lead to serious intra-abdominal infections in immunocompromised patients. The inadequately treated chlamydia likely led to polymicrobial ascension of the genitourinary tract that seeded the transplanted kidney. A high index of suspicion for infection is essential in immunosuppressed patients. Biopsy is crucial for a timely diagnosis.

中文翻译：

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同种异体肾移植物中的多灶性病变

背景

肾移植后的常见并发症包括感染、排斥和恶性肿瘤。移植肾中的多个肿块引起了对恶性肿瘤的怀疑。

案例展示

一名 20 岁女性患有慢性肾病 3 T 期，表现为移植肾压痛、急性肾损伤，超声显示移植肾中存在异质肿块。她在 1 个月前没有得到充分的衣原体治疗，入院时重新检测呈阳性。初步检查显示贫血、高血糖、高尿酸血症和乳酸脱氢酶升高。磁共振成像显示移植肾中存在大小不等的复杂肿块。活检发现无乳链球菌，提示多发性肾周脓肿的诊断。对传染性病因的额外评估未发现异常。经过几个月的抗生素治疗，她的肾周脓肿得到了缓解。

结论

即使没有明确的来源，肾移植患者也可能发生严重感染，否则他们会担心恶性肿瘤。衣原体感染可能导致免疫功能低下患者严重的腹内感染。治疗不当的衣原体可能导致泌尿生殖道中多种微生物的繁殖，从而为移植的肾脏播种。对于免疫抑制患者来说，高度怀疑感染至关重要。活检对于及时诊断至关重要。