Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 10, Number 8, August 2019, pages 229-233

A Case of Intestinal Microsporidiosis in a Renal Transplant Recipient


Figure 1.
Figure 1. Jejunal biopsy containing microsporidia in an enterocyte.
Figure 2.
Figure 2. Proposed diagnostic algorithm for diarrhea in a renal transplant recipient.


Table 1. Differential Diagnosis of Diarrhea in Renal Transplant Recipients
CMV: cytomegalovirus.
Drug related
  Mycophenolate, tacrolimus, antibiotics, proton pump inhibitors, metformin
Infective causes
  Bacterial: salmonella, C. difficile, campylobacter, shigella, yersinia
  Viral: CMV, norovirus and rotavirus
  Parasitic: cryptosporidium, giardia, entamoeba, microsporidia
Surgical causes
  Intra-abdominal sepsis, mesenteric ischemia and colorectal carcinoma
  Coeliac disease, irritable bowel syndrome, malabsorption syndrome, post-transplant lymphoproliferative disorder


Table 2. Diagnostic Investigations for Diarrhea in a Renal Transplant Recipient
CMV: cytomegalovirus.
  Stool: PCR, microscopy
  Blood (serum): blood culture, CMV PCR and quantitative assay, immunosuppressive drug serum assays, immunological test for endomysial antibodies and transglutamase antibodies
  Biopsy: colonic, terminal ileum, gastric, duodenal


Table 3. Summary of Literature Review on Efficacy of Albendazole in Microsporidiosis
Article/referenceIntestinal/disseminated infectionTreatment agent/dose/durationOutcome
Dacha et al [34]Intestinal E. intestinalisAlbendazole 400 mg BD for 4 weeksEffective
Galvan et al [14], patient 1IntestinalInitially metronidazole, on relapse switched to albendazole 400 mg BD for 3 weeksAlbendazole effective
Galvan et al [14], patient 2IntestinalImmunosuppression withdrawal
George et al [8]DisseminatedAlbendazole 400 mg BD, duration not definedEffective
Hocevar et al [26], patient 1Disseminated, E. cuniculiAlbendazole 400 mg BD for 4 monthsEffective
Hocevar et al, 2014 [26], patient 2Disseminated due to E. cuniculiAlbendazole 400 mg BD for 1 year due to relapseEffective