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Diffuse Pulmonary Nodular Infiltrates in a Renal Transplant Recipient*

Elke Ullmer, MD; Heinz Borer, MD; Pierre Sandoz, MD; Michael Mayr, MD; Peter Dalquen, MD; Markus Solèr, MD, FCCP
Author and Funding Information

*From the Divisions of Pneumology (Drs. Ullmer and Solèr) and Nephrology (Dr. Mayr), Institute of Pathology (Dr. Dalquen), University Hospital Basel, Basel; and Department of Internal Medicine (Drs. Borer and Sandoz), Bürgerspital Solothurn, Switzerland.

Correspondence to: Elke Ullmer, MD, Division of Pneumology, University Hospital Basel, CH 4031 Basel, Switzerland; e-mail: EUllmer@uhbs.ch



Chest. 2001;120(4):1394-1398. doi:10.1378/chest.120.4.1394
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A 48-year-old man with end-stage renal disease due to bilateral hydronephrosis had undergone a cadaveric kidney transplantation in April 1990, after 3 years of hemodialysis. His maintenance immunotherapy consisted of cyclosporine, 150 mg/d; prednisolone, 7.5 mg/d; and azathioprine, 125 mg/d. In August 1999, cyclosporine-associated arteriopathy and chronic rejection led to progressive graft failure, and he was evaluated for retransplantation. Unexpectedly, the chest radiograph revealed bilateral confluent alveolar opacities, with a nodular, fluffy appearance observed on high-resolution CT (Fig 1, 2 ). The patient denied fever, cough, weight loss, night sweats, or dyspnea. Results of pulmonary function testing and arterial blood gas analysis were normal; only a metabolic acidosis was noticed. Physical examination detected hypertension (BP, 184/97 mm Hg), obesity (body mass index, 30), a grade 2/6 aortic ejection murmur, and edema of the legs. Results of chest and abdominal examination were normal. Lymph nodes were not enlarged, and no skin lesions could be seen.

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