Two donor-related infections in a heart transplant recipient: One common, the other a tropical surprise

BACKGROUND Infection is the most frequent complication after heart transplantation (HTx) In this report and brief literature review we present a recipient who some 6 weeks post HTx had two donor related infections a "common' primary cytomegalovirus (CMV) infection and simultaneously a highly unusual donor-related Strongyloides stercoralis infection METHODS The parasite was discovered by chance in a skin biopsy CMV was treated with ganciclovir and the strongyloidiasis was cured with two courses of anti-helminthic therapy initially with ivermectine and albendazol and, in response to eosinophilia with ivermectine monotherapy The patient s recovery was further complicated by two successive rejection episodes a relapse of the CMV syndrome and a novel influenza A/H1N1 infection These episodes were treated with steroids ganciclovir and oseltamivir respectively RESULTS It took almost 9 months before a permanent IgG anti-CMV response was seen At 13 months post-HTx coronary angiography showed only slight vessel wall abnormalities At present the patient is back at home and in good condition CONCLUSION Until now only 4 recipient-derived strongyloidiasis cases have been described in post HTx patients all diagnosed by autopsies This is the first report of a donor related Strongyloides infection in a patient after HTx J Heart Lung Transplant 2010 29 1433-7 (C) 2010 International Society for Heart and Lung Transplantation All rights reserved