Salmonella Appendicitis in Renal Transplantation

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].