Severe respiratory syncytial virus pneumonia in a kidney transplant recipient with desensitization: Case report and comprehensive review of the literature

Herein, we report a rare case of severe respiratory syncytial virus pneumonia after kidney transplant in a 46-year-old woman. The patient was diagnosed with end-stage renal disease and underwent living-donor kidney transplant. Direct flow cytometry crossmatch testing yielded positive results, and desensitization treatment with rituximab, plasmapheresis, and immunoglobulin was performed before transplant. There were no complications. Five days after discharge, the patient was readmitted with a 2-day history of fever and diagnosed with bilateral pneumonia. The patient was placed on mechanical ventilation and given renal replacement therapy. Respiratory syncytial virus in the bronchial washings was detected via polymerase chain reaction. Broad-spectrum antibiotics, intravenous methylprednisolone, and immunoglobulin were administered. Over-immunosuppression strategies, such as desensitization therapy, may result in severe respiratory syncytial virus pneumonia, even in kidney transplant recipients.