A routine kidney transplant for a 61-year-old man took a dire turn when he developed a life-threatening parasitic infection that was undetected prior to the surgery.

Doctors at Massachusetts General Hospital suspected an infection but faced challenges in diagnosis due to the patient's immunosuppressive medications.

The medical team investigated various potential infections, given the patient's compromised immune system from transplant medications.

Dr. Camille Kotton and her team utilized a process of elimination, identifying elevated eosinophil levels and unusual signs such as a rash, which pointed towards a parasitic infection.

Further investigation revealed that the donor had lived in the Caribbean, a region where the parasitic roundworm Strongyloides is prevalent, and tests confirmed the presence of antibodies against the parasite in the donor's blood.

Testing confirmed the presence of worm larvae in the patient's lungs and stool, leading to treatment with ivermectin, which resulted in a gradual recovery.

The patient's history included contact with domestic cats and dogs, which raised suspicion for a widespread parasitic infection, although common bacterial infections were ruled out.

Despite treatment, the patient's condition deteriorated over ten days, resulting in acute respiratory failure and shock, necessitating mechanical ventilation and transfer to the ICU.

Two months post-surgery, the patient was hospitalized with severe symptoms including vomiting, fatigue, excessive thirst, and fluid accumulation in the lungs.

In a surprising twist, the recipient of the donor's other kidney also fell critically ill with the same parasite, but both patients ultimately survived.

In response to this incident, the United Network for Organ Sharing has updated its screening guidelines to include universal Strongyloides testing for organ donors from endemic regions.

The patient experienced a range of severe symptoms, leading to hospitalization two months after the transplant.