Abstract
A 64-year-old man presented to the emergency department in the summer with intermittent fevers that began 7 weeks after he underwent heart transplantation at that hospital. The patient had a history of ischemic cardiomyopathy for which he had received a HeartMate II left ventricular assist device (LVAD) that remained implanted for 2 years. An infection with coagulase-negative staphylococcus had developed in the drive-line of the device, a finding that led to the patient's name being placed higher on the waiting list for transplantation; before transplantation, he had received long-term treatment with doxycycline for suppression. His initial postoperative course was uneventful. After receiving induction therapy with basiliximab, the patient was treated with mycophenolate mofetil, tacrolimus, and prednisone to prevent allograft rejection. He received trimethoprim-sulfamethoxazole and valganciclovir for prophylaxis against pneumocystis and cytomegalovirus (CMV) infections (the patient and donor were both CMV-seropositive). Four weeks after heart transplantation, an endomyocardial biopsy showed grade 2 acute cellular rejection, which prompted administration of pulse therapy with methylprednisolone for 3 days and increased maintenance doses of immunosuppressive therapy. His treatment with tacrolimus was changed to cyclosporine because of tremors. Seven weeks after transplantation, he began to have intermittent high fevers with temperatures of up to 40 degrees C, along with chills, nausea, and headaches.