Background: There is an increasing amount of
data associating MBL deficiency with a higher susceptibility
to meningococca[ disease. In addition,
meningococca[ disease has been reported in patients
with various immunosuppressive conditions.
However, to our knowledge, only three cases of
meningococca[ disease have been reported in solid
organ recipients (SOT).
Methods & Results: A 32 year-old male patient underwent
cadaveric kidney transplantation for endstage
renal disease of unknown origin. On day 71
post-transplantation he developed fever (39.6°C),
shaking chilis, and tachycardia without hypotension.
At this time, immunosuppression consisted
of tacro[imus, prednisone 10mg daily and mycopheno[
ate mofeti[ 2 g daily. Physical examination
on admission was normal, except for two small
petechia[ lesions on the forearm. No meningeal
signs were present. Three sets of blood cultures
grew Neisseria meningitidis group C susceptible to
ceftriaxone (MIC=0.003mg/[). Antibiotic therapy
consisted in intravenous ceftriaxone 2 g per day for
a total duration of 7 days. Serum immunog[obu[in
levels, C3, C4 and CHS0 were normal However, using
a method to screen for the functional activity of
a[[ three pathways of complement (Wies[ab, Lund,
Sweden), no activation via the MBL pathway could
be detected (0%). A subsequent quantification of
MBL pathway components revealed normal levels
of MASP 2 but undetectab[e amounts of MBL (below
10 ng/m[, normal range: >500 ng/m[).
Conclusion: Since the exact incidence and the possible
relationship between meningococca[ disease
and organ transplantation is not we[[ understood,
we strongly encourage transplantation centers to
report additional cases. The potential clinical usefu[
ness of screening SOT candidates for MBL deficiency
in relation to infectious complications after
transplantation remains to be determined.