Case reports of possible invasive aspergillosis in kidney transplant recipients at the “Dr. Juan José Fernández” National Hospital, Zacamil

Abstract

Introduction: Invasive aspergillosis (IA) is a serious opportunistic infection in kidney transplant (KT) recipients, associated with high morbidity and mortality and diagnostic challenges in the context of immunosuppression. Methods: An observational, descriptive, and retrospective study was conducted in a tertiary care hospital. Since the start of the kidney transplant program in 2023, 30 transplants have been performed; three patients that developed IA constituted the study sample. Medical records were reviewed, including medical history, immunosuppressive therapy, laboratory tests, and imaging studies. The diagnosis was based on clinical-radiological correlation, supported by cultures and biopsy. Results: The three patients, all with a history of chronic kidney disease (CKD) on hemodialysis, developed pulmonary aspergillosis between the first and fifth month after transplantation. Two patients experienced acute rejection, which was treated with steroids and rituximab. CT findings included cavitary lesions, consolidations, and characteristic signs such as air halos and air crescents. All received voriconazole; however, the outcome was unfavorable, with death occurring between 4 and 8 months after transplantation. Conclusion: IA in KT recipients is rare but highly lethal. Early clinical suspicion and timely use of imaging are essential for improving prognosis.