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• W3157050351 abstract "American Journal of Transplantation Images in Transplantation – Continuing Medical Education (CME) Each month, the American Journal of Transplantation will feature Images in Transplantation, a journal-based CME activity, chosen to educate participants on current developments in the science and imaging of transplantation. Participants can earn 1 AMA PRA Category 1 Credit™ per article at their own pace. This month’s feature article is titled: “Pulmonary nodules in a lung transplant recipient.” Accreditation and Designation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of John Wiley & Sons, Inc., the American Society of Transplant Surgeons, and the American Society of Transplantation. John Wiley & Sons, Inc. is accredited by the ACCME to provide continuing medical education for physicians, and fulfills the requirements for the American Board of Surgery (ABS) for Maintenance of Certification (MOC). John Wiley & Sons, Inc. designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Statement of Need The differential diagnosis for pulmonary nodule in the posttransplant patient is broad and includes infectious (i.e., bacterial, fungal) and noninfectious causes (i.e., malignancy, rheumatologic disease). The diagnostic workup presents unique challenges for transplant physicians and surgeons, particularly when evaluating the role of laboratory and microbiologic tests, radiography, and treatment. Purpose of Activity This activity was designed to improve patient outcomes by challenging the learner to evaluate their own knowledge of commonly used diagnostic tests and demonstrating how to use the test results to appropriately manage a patient who may present in a similar fashion. Identification of Practice Gap Patients undergoing lung transplantation are at risk of opportunistic infections. The management of infectious complications in transplant recipients requires clinicians to recognize specific risk factors and to be aware of available diagnostic tools, including their limits in terms of sensitivity and specificity. This activity will illustrate the importance of assessing patient risk factors, as well as the optimal diagnostic and therapeutic management as it relates to pulmonary nodules in the transplant recipient. Upon completion of this educational activity, participants will be able to: Learning Objectives Target Audience This activity has been designed to meet the educational needs of physicians and surgeons in the field of transplantation and to assist in diagnosis and treatment of transplant-associated infectious diseases. Disclosures No commercial support has been accepted related to the development or publication of this activity. John Wiley & Sons, Inc. has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable. Editor-in-Chief Sandy Feng discloses stock ownership or equity in Johnson & Johnson; and consulting or advisory roles for Ambys, California Institute for Regenerative Medicine, CSL Behring, FDA Cellular Tissue and Gene Therapies Advisory Committee, Syncona, and the University Grants Committee, RGC Biology and Medicine Panel. Editors Matthew H. Levine has no relevant financial relationships to disclose. C. Kristian Enestvedt has no relevant financial relationships to disclose. CME Manager, ASTS Ellie Proffitt has no relevant financial relationships to disclose. Authors Anita Shallal, Robert Tibbetts, George Alangaden, and Jonathan Williams have no relevant financial relationships to disclose. This manuscript underwent peer review in line with the standards of editorial integrity and publication ethics maintained by the American Journal of Transplantation. The peer reviewers have no relevant financial relationships to disclose. The peer review process for the American Journal of Transplantation is blinded. As such, the identities of the reviewers are not disclosed in line with the standard accepted practices of medical journal peer review. Instructions on Receiving CME Credit This activity is designed to be completed within an hour. Physicians should claim only those credits that reflect the time actually spent in the activity. This activity will be available for CME credit for 12 months following its publication date. At that time, it will be reviewed and potentially updated and extended for an additional 12 months. Physicians must correctly answer 75% or more of the posttest items to claim MOC credit. Follow these steps to participate, answer the questions and claim your CME credit: A 72-year-old man presented with a 1-month history of cough, shortness of breath, weight loss, and fatigue. Ten months earlier he underwent bilateral lung transplantation (cytomegalovirus [CMV] donor negative/recipient positive, Epstein–Barr virus [EBV] recipient positive) for idiopathic pulmonary fibrosis, with basiliximab and methylprednisolone induction followed by tacrolimus and prednisone maintenance. Early posttransplantation course was complicated by bilateral anastomosis stenosis with pseudomembrane formation and Pseudomonas aeruginosa pneumonia. Posttransplant, he did not require treatment for transplant rejection. The patient received antifungal prophylaxis with inhaled liposomal amphotericin-B and CMV prophylaxis with valganciclovir for the first 3 months after transplantation. At the time of hospitalization, he was receiving trimethoprim-sulfamethoxazole for prophylaxis and azithromycin for prevention of bronchiolitis obliterans syndrome. On examination, he was afebrile. Breath sounds were diminished in the right base. He had a normal white blood cell count of 8.3 × 103/µl and an elevated C-reactive protein of 2.8 mg/dl. Contrast tomography (CT) of the chest revealed right pleural effusion and nodular opacities in the right and left lower lobes (Figure 1). He was initiated on ceftriaxone and azithromycin for suspected pneumonia. Thoracentesis demonstrated exudative pleural effusion and Staphylococcus haemolyticus was isolated on fluid culture. The serum Aspergillus galactomannan was elevated at 2.56 index. The fatigue, weight loss, and positive EBV serology was concerning for concomitant lung malignancy or posttransplant lymphoproliferative disorder (PTLD), and a bronchoscopy and transbronchial biopsy was performed. No evidence of malignancy was found on pathology. The macroscopic and microscopic appearance of the pathogen isolated from bronchoalveolar lavage is shown in Figures 2 and 3. The patient underwent additional treatment. To complete this activity and earn credit, please go to https://www.wileyhealthlearning.com/ajt" @default.
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• W3157050351 date "2021-05-01" @default.
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• W3157050351 title "Pulmonary nodules in a lung transplant recipient" @default.
• W3157050351 doi "https://doi.org/10.1111/ajt.16520" @default.
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