CASE VIGNETTE:
A 47-year old male kidney transplant recipient (KTR) was admitted with fever and a month history of shortness of breath that had progressed from medium efforts to rest.
Past medical history
- 2003 – Diabetes Mellitus, Hypertension, Obesity and Polycystic Kidney Disease
- 2005 – Started Renal Replacement Therapy for Chronic Kidney Disease
- 2007 – Renal Transplantation from an allogenic cadaveric donor
- 2009 – Several hospitalizations because of difficulties in ambulatory glycemic control and severe dyslipidemia. Sirolimus was started two months before the current admission
Current drug therapy
- Mycophenolate mofetil (1 g) BID
- Prednisone (7.5 mg) QD
- Sirolimus (3 mg) QD (blood trough level: 8.6 ng/mL – 12/18/09)
- Cipofibrate (100 mg) BID
- Omeprazole (20 mg) BID
- Intermediate-acting Insulin50 UI sc a.m. y 40 UI sc p.m.
- Regular Insulin 25 UI sc before meals
Clinical Status at Hospitalization
On admission his physical examination was: blood pressure 100/70, pulse 80 per min, respiratory rate 20 per min and temperature 38°C. He seemed well, not in distress, breathing sounds were normal on both sides of the thorax and heart auscultation was normal. No edema was noticed. Beside the obesity, the rest of his physical examination was normal.
Figure 1. Chest X-Ray on admission day
X- Ray shows bilateral lower lobe infiltrates, with no pleural effusion