O transplante renal bem sucedido melhora a qualidade de vida e reduz o risco de mortalidade para a maioria dos doentes quando comparado à terapêutica dialítica de manutenção. Os autores apresentam o caso clinico de uma doente de 61 anos com doença renal crónica estadio 5-d que foi transplantada com um rim de dador cadaver. A doente desenvolveu diabetes no periodo pós-transplante precoce e teve uma pneumonia a Pneumocystis jirovecii. A creatinina basal era de cerca de 1,1 mg/dL. A doente foi admitida por quadro com cerca de 7 dias de febre, tosse produtiva, anorexia e mobilidade e ensibilidade alteradas na mão direita. Foi-lhe diagnosticada pneumonia a Aspergillus fumigatus e a ressonância magnética craneoencefálica foi sugestiva de Síndrome de Leucoencefalopatia Posterior Reversível, possivelmente relacionada com níveis séricos elevados de tacrolimus. Cerca de um mês depois, aquando da realização de ecografia renal e posteriormente tumografia computorizada, foi-lhe diagnosticada neoplasia renal, tendo sido submetida a nefrectomia direita. Após a alta a doente tem sido avaliada em consulta, mantendo creatinina sérica estável de cerca de 2,3 mg/dL, sem sintomatologia associada. Este caso clinico evidencia a multiplicidade de potenciais complicações a que os doentes transplantados renais estão sujeitos em virtude da terapêutica imunosupressora a que são submetidos.

Successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared to maintenance dialysis. We present the case of a 61-year-old woman with chronic kidney disease stage 5-d who received a deceased donor renal transplant. At 21 months after transplantation she developed early post-transplant diabetes and was diagnosed with Pneumocystis jirovecii pneumonia. Her basal creatinine level was 1.1 mg/dL. The patient was admitted with a 7-day history of fever, productive cough, anorexia and right hand altered mobility and sensibility. She was diagnosed with Aspergillus fumigatus pneumonia and the encephalocranial magnetic resonance was suggestive of posterior reversible encephalopathy syndrome, possibly related to high tacrolimus serum levels. Approximately a month later, a renal ultrasound scan and further abdomen computed tomography scan (CT) suggested a tumour and the patient was submitted to right nephrectomy. After discharge, she has been regularly evaluated, maintaining a stable serum creatinine of 2.3 mg/dL, no symptoms associated. This clinical case highlights the myriad of potential complications that transplant recipients are vulnerable to when receiving immunosuppressive therapy.

A cross-sectional study was conducted in 151 (71.6%) of 211 male inmates of a regional Portuguese prison in order to establish the seroprevalence for viral hepatitis (HAV, HBV, HCV), human immunodeficiency virus (HIV), syphilis and herpes simplex virus (HSV-1 and HSV-2) and to analyze some psychosocial and criminal characteristics. Mean age was 34 years. Anti-HAV was positive in 69.5% (n = 105) and in 34.4% (n = 52) for anti-HCV. One (0.7%) person had HBsAg and 29 (19.2%) had laboratory markers of past HBV infection. Non-immune inmates for HBV were 40.4% (n = 61). Syphilis was diagnosed in 6.0% (n = 9). The rate of HIV infection was 6.6% (n = 10; all HIV-1). The seropositivity of HSV-2 was 19.9% (n = 30) and of HSV-1 was 82.1% (n = 124). Alcohol dependence was reported by 26.5% (n = 40). Excluding tobacco and prescription medication, 73.5% (n = 111) reported drug use in prison. The most commonly used drugs were: cannabis (100%; n = 111) followed by heroin (56.7%; n = 63). Anti-HCV rate was noteworthy. The HIV infection rate (6.6%) in this regional prison is at least 13 to 22 times greater than in general population. As the inmate return to the community increases the risk of disease exposure for the general population, early detection and counseling is urgently needed for prisoners.