Late lymphocele infection with Parvimonas micra in a kidney allograft recipient

TL;DR

A kidney transplant patient developed a late infection in a lymphocele caused by Parvimonas micra, a bacteria from the mouth, six years after the transplant.

Contribution

This case highlights a rare late lymphocele infection caused by Parvimonas micra in a kidney transplant recipient.

Findings

A lymphocele infection occurred six years post-transplantation with Parvimonas micra.

Treatment required surgical intervention and prolonged antibiotic therapy for clinical remission.

The infection was linked to the patient's history of dental periodontal treatments.

Abstract

Lymphocele infection is a frequent and usually early complication following renal transplantation. We report the case of a transplanted patient with a chronic lymphocele that became infected six years after transplantation Parvimonas micra, a commensal of the human oral cavity.

The patient had a stable lymphocele for six years post-transplantation, as observed through several medical imaging studies, without the need for intervention due to the absence of any impact on graft function. Regarding a six-month progressive decline in general condition, a persistent inflammatory syndrome and a deterioration of renal function, a PET scan revealed a hypermetabolic infiltration behind the lymphocele adjacent to the graft. Bacterial superinfection with Parvimonas micra was diagnosed by an exploratory puncture. The patient had a history of dental periodontal treatments. The initial attempt at treatment with radiological drainage and three months of antibiotic therapy was unsuccessful. Faced with radiological deterioration despite treatment, the patient underwent surgical intervention for lavage with necessary antibiotic therapy for an additional six weeks. He achieved clinical remission, but metabolic activity persists within the site of a residual collection, and the patient remains closely observed.

Infected lymphoceles should be considered in the differential diagnosis for patients presenting with nonspecific infectious and inflammatory symptoms, regardless of the time elapsed since renal transplantation. The treatment of this complication can be complex.

Figures