Man receives kidney transplant, then body becomes riddled with worms, doctors say
The 61-year-old man received a new kidney from a deceased donor after being diagnosed with 'nephrosclerosis-related end-stage kidney disease,' or chronic high blood pressure that causes hardening of the walls of arteries in the kidneys, according to a June 18 case report published in the Case Records of the Massachusetts General Hospital.
The transplant was successful and the man was sent home with care instructions just four days later, doctors said.
Six weeks later, the man attended a follow-up visit where doctors saw a slightly elevated creatinine level and hyperglycemia, the former an indicator of kidney function and the latter indicative of diabetes, according to the report. He was sent home with a weekly injection of semaglutide, the active ingredient in drugs like Ozempic and Wegovy.
Then his health took a turn.
Successful transplant turns critical
A week later, the 61-year-old was scratched by his cat and his ankle began to swell, doctors said. He started to feel tired and nauseated the next week, then started throwing up and drinking excessive amounts of water, according to the case report.
He was admitted to the hospital again, and over the next ten days, his heart rate increased significantly, his breathing decreased until he needed to be put on a ventilator, doctors said.
Hoping for answers, his medical team turned to his previous medical history for something that might have been missed.
The 61-year-old had been on the transplant list for 6 years, according to the report, and he had diabetes and spent much of his life as a smoker.
He had lived in New England his entire life and hadn't traveled. He enjoyed gardening, and had healthy cats and a dog at home with his wife.
Then the rash appeared.
Purple and blotchy, the rash stretched across his stomach as his abdomen grew to become large and hard, and normal bowel sounds were absent, according to the report.
By this point, the man was described as 'critically ill,' and because the man was on immunodepressants to help his body transition to the new organ, doctors compared the man's symptoms to other examples of infections.
'Given that the patient's presentation is not consistent with a drug reaction or rejection of the kidney allograft, I think that the most likely explanation for his critical illness is a disseminated parasitic infection,' Camille N. Kotton, an infectious disease and transplant expert, wrote in the report.
The man was diagnosed with 'donor-derived disseminated strongyloidiasis,' or an infection caused by parasitic roundworms, doctors said.
What are roundworms?
The roundworms, also called threadworms, can infect humans directly, but can also be passed to humans through contact with monkeys or domestic dogs, according to the Centers for Disease Control and Prevention.
In this man's case, the source of the infection was his new kidney, donated from someone who lived in the Caribbean before their death and who had not been tested for strongyloides before the donation, according to the case report.
Between 2008 and 2017, the Organ Procurement and Transplantation Network, the group that oversees organ donation in the United States, reported 14 out of 10,000 organ donations could result in disease transmission, or about 0.14% of donations, doctors said.
'Unfortunately, many of these events are varied and unexpected, involving a long list of pathogens ranging from viruses to bacteria and parasites,' doctors wrote. 'Although we have contemplated how to avoid such transmissions, many seem unavoidable and result in undesirable circumstances.'
The man was successfully treated with ivermectin, an antiparasitic drug, and doctors contacted the organ board to see if any other patients had received organs from the same donor, according to the report.
A 66-year-old man had received the donor's other kidney, doctors said, and his medical team was contacted to begin treatment for the infection after he had already been showing similar symptoms.
Both men fully recovered and their transplants were successful, according to the report.
The medical team includes Kotton, Rory L. Cochran, Alan M. Sanders, Kassem Safa and Maxwell T. Roth.
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