PITTSBURGH pneumonia agent (PPA), also known as TATLOCK and HEBA, and tentatively ascribed to the genus Legionella (L micdadei), has recently been identified as a cause of pneumonia in patients receiving high-dose steroid therapy for rejection of renal transplants.1-4 We report a case of a rapidly expanding pulmonary nodule caused by PPA in an immunosuppressed renal transplant patient.
Report of a Case
A 59-year-old man had a cadaveric renal transplantation because of renal failure caused by familial polycystic kidney disease. After transplantation, he was given prednisone, 2 mg/kg/day, and azathioprine, 3 mg/kg/day. During the next six weeks of hospitalization, he had four episodes of acute graft rejection, each treated with methylprednisolone sodium succinate pulse therapy, 30 to 90 mg/kg/day for three days. He was discharged from the hospital with instructions to take prednisone, 70 mg/day, and azathioprine, 50 mg/day, but was readmitted one week later for a rising serum