Expressive aphasia in lung transplant recipient
Shankari Ravichandran
Columbia University Medical Center, USA
: J Nurs Patient Care
Abstract
Progressive multifocal leukoencephalopathy (PML) is associated with John Cunningham polyomavirus (JCV) infection of central nervous system oligodendrocytes, resulting in demyelination and progressive focal neurologic deficits. In the setting of immunosuppression, reactivation of dormant JCV has been noted in patients with human immunodeficiency virus (HIV). I would like to present a case history of a post single lung transplant recipient, 66-years of age, female, cytomegalovirus seropositive, epsteinbarr virus (EBV) seropositive, chronic obstructive pulmonary disease (COPD) patient, who presented with symptoms of aphasia associated with word-finding difficulties and swaying to one side when walking lasting one week, which progressively worsened. A diagnosis of PML was established via brain biopsy and correlating brain images. This case outlines the difficulty of balancing immunosuppression for post lung transplant patient, in the setting of an established diagnosis of PML. The patient died as PML symptoms progressed in the setting of decreased immunosuppression from respiratory failure secondary to acute rejection.
Biography
Shankari Ravichandran is a Senior Transplant Nurse Practitioner in the Lung Transplant Program at Columbia University Medical Center in New York. As a Senior Member of the Transplant team at Columbia, she supports the program with her wide cardiothoracic and administrative expertise to be recognized as a Blue Ribbon Center of Excellence nationally. She has established an Electronic Medical Record Template for the optimization of care for the outpatient post-transplant patients, along with a clinical education and comprehensive clinical support base for clinical transplant nurse mentorship program in New York. She is a Medical Advisor and Board Member of a grass root patient supported philanthropy, “The Lung Transplant Project” which supports on-going research for immune tolerance at Columbia University immunogenetic laboratory. She received her Master’s degree in Nursing with an ANCC Family Nurse Practitioner from Pace University in New York. Currently she is in the process of completing her Doctorate degree in Clinical Practice at Columbia University School of Nursing, where she is an Associate Professor for Clinical Nursing.
