[Case Report] 42yo male with fever following liver transplant

02/11/25 • 26 min

This case report describes a 42-year-old male from Arizona with a complex course characterised by fever following an orthotopic liver transplant. A general approach to fever in the post-transplant patient is discussed, along with specific considerations regarding travel in post-transplant patients or those on immunosuppressants for other indications. A/Prof Camille Kotton and Dr Simran Gupta from the Massachusetts General Hospital and Brigham and Women’s Hospital take listeners through the case and related issues in a step-by-step manner at a level targeted for trainees and generalists.

Guest A/Prof Camille Kotton (Massachusetts General Hospital, Harvard University)Dr Simran Gupta (Brigham and Women’s Hospital, Harvard University)
Hosts
Associate Professor Stephen Bacchi FRACP (Fulbright Fellow, Mass General Brigham; University of Adelaide)
Christina Gao (University of Adelaide)

ProductionProduced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Editorial feedback kindly provided by doctors Maansi Arora, Brandon Stretton, Matt Lim and Ben Cook.

Key Reference (Spoiler Alert)

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Coccidioidal Meningitis after Liver Transplantation in a Nonendemic Region: A Case Report [Transplantation 2006]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Editorial feedback kindly provided by doctors Maansi Arora, Brandon Stretton, Matt Lim and Ben Cook.

Key Reference (Spoiler Alert)

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Coccidioidal Meningitis after Liver Transplantation in a Nonendemic Region: A Case Report [Transplantation 2006]

Previous Episode

Ep122: Funding pan-cancer therapies

In the previous episode we heard how some rationally-designed therapies work on almost any cancer with the right molecular signature. Tumour-agnostic medications could be godsend for patients with rare cancers which have classically been overlooked by drug developers, and those with advanced cancers of unknown origin. 15,000 such patients have undergone comprehensive genome profiling of their tumours through the organisation, Omico. In this podcast, Omico’s founder explains that while the majority have received recommendations about matched therapies, clinical trials are typically the only way to enable access. Professor David Thomas discusses why Australia’s Health Technology Assessment process appears to be so conservative and how the market price of next-generation oncotherapies might be brought down by changes across the local ecosystem.

Guest Prof David Thomas FRACP PhD (Director, Centre for Molecular Oncology UNSW; Founder and Chief of Science, Omico)
Professor Thomas or Omico have received grants, consultancies or research support from Roche, Astra Zeneca, Pfizer, Eisai, Illumina, Beigene , Elevation Oncology, RedX Pharmaceuticals, SunPharma , Bayer, George Clinical, Novotech , Merck Sharpe and Dohme, Boehringer Ingelheim, Hummingbird, Microba , BioTessellate , PMV Pharma, Australian Unity and Foundation Medicine.

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Multicolor’ and ‘Pulse Voyage’ by Chill Cole. ‘Impulsing’, ‘the City of Hope’ ‘Over Again’, and ‘Going Undercover’ by Borrtex provided courtesy of FreeMusicArchive. Image by Guido Mieth licenced through Getty Images.
Editorial feedback kindly provided by RACP physicians Simeon Wong, Stephen Bacchi. Thanks also to Kym Bramich and Arnika Martus on staff with Omico and RACP respectively.

Next Episode

Ep124: Pleural medicine comes of age

Professor Gary Lee established the first dedicated pleural service in the southern hemisphere in 2009, at the Sir Charles Gairdner Hospital in Perth. He says that pleural disease has finally come to be regarded as an area of subspeciality interest in its own right, not just a complication of other comorbidities. In this podcast he presents a potted history of key developments in the management of pleural effusion in particular.

This is diagnosed in about 60,000 people every year in Australia, mainly as a result of infection or malignancy. With mentors in the UK, Professor Lee conducted some of the earliest trials on fibrinolytics and DNAses to break down purulent effusions. They also put to the test protocols for pleurodesis via talcum insufflation that date back to the 1930s.

Professor Lee’s more recent clinical research has focused on the use of indwelling pleural catheters that a patient can use to drain pleural effusate when feeling breathless. He has also a made an important contribution to conservative management guidelines for primary spontaneous pneumothorax. This story is great example of how clinical practice emerges imperfectly from a soup of evidence, accidents, human biases and system.
Guest Prof Gary Lee PhD FRACP FRCP FCCP (Pleural Service, Sir Charles Gairdner Hospital in Perth; University of Western Australia).
Co-host
Dr Marion Leighton FRACP (Wellington Hospital).

ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Reconstruct’ by Amaranth Cove, ‘Nagba Algooah’ by Ebo Krdum. ‘Vittoro’ by Borrtex provided courtesy of FreeMusicArchive. Image by ilbusca licenced through Getty Images.
Editorial feedback kindly provided by RACP physicians Aidan Tan, Maansi Arora, Simeon Wong, Hugh Murray and Vanessa Wong.