Transplant Immunosuppression


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Adapted from:

Sandeep Mukherjee and Urmila Mukherjee, “A Comprehensive Review of Immunosuppression Used for Liver Transplantation,” Journal of Transplantation, vol. 2009, Article ID 701464, 20 pages, 2009. doi:10.1155/2009/701464

Choosing Wisely – Infectious Diseases Society of America

The Infectious Diseases Society of America (IDSA) last week released its list of tests or procedures whose necessity should be questioned, as part of the ABIM Foundation’s Choosing Wisely initiative.

The recommendations are as follows:

1. Don’t treat asymptomatic bacteriuria with antibiotics.

2. Avoid prescribing antibiotics for upper respiratory infections.

3. Don’t use antibiotics for stasis dermatitis of lower extremities.

4. Avoid testing for a Clostridium difficile infection in the absence of diarrhea.

5. Avoid treatment with antibiotics for mitral valve prolapse.

Case Challenge #6

A 34 yo male with AIDS, currently on treatment for disseminated Histoplasmosis, is admitted with fever and hypotension. He has been on therapy for this infection for the last 4 months, and was doing well. However, he notes that he has become gradually more tired and has a decreased appetite. 2 days prior to this presentation, he underwent emergency surgery for a broken arm after a fall. After the procedure, he developed fever and hypotension on POD #1 and broad spectrum antibiotics were started. Currently, he remains febrile and has nausea, vomiting, and abdominal pain.

PE: Tmax 100.8, HR 115, BP 90/60. Abd TTP but no rebound.

Labs: WBC 12k (70% PMN, 5% Eos), h/h stable, Na 128, K 5.4, Cr 1.6, blood Cx ngtd.


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