Clinical Reasoning: Agitation and psychosis in a patient after renal transplantation

This is the authors' abstract. We don't add key points for this paper.

A 31-year-old woman was admitted for fever and altered mentation of unclear etiology 16 months after a renal transplant. This was her third admis-sion in 4 months for fever of unclear etiology, but the current admission differed in that she also demonstrated short-term memory loss, dramatic mood swings, agitation, and paranoid delusions. Other significant medical history included non-Hodgkin lymphoma in childhood for which she underwent 2 allogeneic stem cell transplants, chemotherapy, and whole-body radiation. She also developed postradiation kidney failure which ne-cessitated a cadaveric kidney transplant followed by immunosuppression with tacrolimus 2 mg BID and mycophenolate 1 g BID. Questions for consideration: 1. What is the most likely etiology of rapid onset altered mental status and fever in the context of immunosuppression? 2. What are the initial tests to consider for this etiology? GO TO SECTION 2 Correspondence & reprint