%0 Journal Article
%T Salmonella Appendicitis in Renal Transplantation
%A B. Malone
%A S. Kleyman
%A A. Sanni
%A N. Sumrani
%A D. Distant
%J Case Reports in Transplantation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/402735
%X While appendicitis remains one of the commonest surgical diseases, there are relatively few reports following renal transplantation. A 33-year-old man was admitted with diarrhea, fever, and epigastric pain 7 years following a cadaveric renal transplant. CT scanning confirmed a diagnosis of appendicitis which was removed within 24 hours of admission. Histology and blood cultures following surgery confirmed Salmonella type b appendicitis. Patient was safely discharged home 5 days following hospital admission. 1. Introduction Acute appendicitis remains one of the commonest causes of an acute abdomen with an estimated 7% of the population developing it in their lifetime [1]. Salmonella is rarely associated with appendicitis but can cause it by direct invasion of the appendix, causing inflammation of the appendix, ileum, or lymph nodes [2]. However, appendicitis is very rare following renal transplantation because immunosuppression with corticosteroids is expected to prevent lymphoid hyperplasia [3]. We present a case of Salmonella appendicitis in a renal allograft recipient. 2. Case Report A 33-year-old man received a renal allograft from a cadaveric donor on February 5, 1999. The kidney was placed in the right iliac fossa. Maintenance immunosuppression was tacrolimus 4£¿mg twice daily and prednisone 10£¿mg once daily. On August 10, 2006, he presented with a 1-month history of diarrhea and a 6-day history of fever, epigastric pain, and vomiting. The pain was a burning sensation across the LUQ radiating to the back with associated bile-stained vomitus. On examination, he appeared dehydrated with stable vital signs apart from pyrexia of 104.2£¿F. Abdominal examination elicited tenderness over the RLQ area with normoactive bowel sounds and no flank tenderness. His abdomen was soft with associated guarding and rebound. Laboratory tests showed a normal white count (8,500/mm3) with a mild left shift in the neutrophil bands and a slight increase in his creatinine (2£¿mg/dL) from baseline. The CT scan suggested appendicitis, and patient was scheduled for a laparoscopic appendectomy with possible conversion into an open procedure. On open laparotomy, we found a grossly inflamed appendix with no signs of perforation or abscess formation. Postoperatively, histology of the specimen and blood cultures confirmed Salmonella group b bacteria infection. This was successfully treated with antibiotics, and patient was discharged home 5 days later. 3. Discussion Following renal transplantation, gastrointestinal complication is the second most common event after infection [4].
%U http://www.hindawi.com/journals/crit/2013/402735/