FEVER IN DIALYSIS PATIENTS WITH RECENTLY REJECTED RENAL-ALLOGRAFTS

Introduction. Fever of unknown origin is a complex problem in dialysis patients with recently rejected renal allografts, due to the contribu tion of the newly withheld immunosuppressive agents to the immunosuppr ession of uremia, resulting in an atypical presentation of infections, a main cause of fever in these cases. Materials and Methods. Two dial ysis patients with recently rejected renal allografts who were hospita lized because of fever of unknown origin are reported. Biochemical, ba cteriological and imaging studies were performed for specific diagnosi s. Results. Extensive laboratory investigations failed to yield any di agnosis and allograft nephrectomy was performed in one patient, with a probable diagnosis of inflammation of the allograft, which resulted i n no improvement. Eventually both patients were found to have adrenal insufficiency responsible for the fever, which improved after steroid replacement. Conclusions. Adrenal insufficiency should be suspected in all dialysis patients presenting with fever and atypical symptoms, bu t only after other potential causes are eliminated; since steroid admi nistration may normalize fever regardless of the etiology, if may mask the signs and symptoms and delay the treatment of other (if any) unde rlying disorder(s).