In india it is due either to fungus or TB. Patient can be salvaged by careful reduction of immunosuppression from triple to dual ( only cni and 5 mg corticosteroid ) along with targetted therapy for the organism. They are poor candidates for surgical intervention.

It is a bad problem to have. Extremely important to reach a microbiological diagnosis. Early and aggressive invasive tests like bronchscopy, biopsies, use of new tests like galactomannan for apergillus. Please also remember the likelihood of infections with multiple organisms, especially background CMV, etc.

We had post KT pt with cavitatory PCP pneumonia , Co infection with coliform and MTB, who survived .

Nocardia is another organism which can also cause cavitary pneumonia in renal transplant recipients

Likely organisms (in U.S.) based on review by Gadkowski and Stout "Cavitary Pulmonary Disease" in Clin. Microbiol. Rev. April 2008 vol. 21 no. 2 305-333, full text at: http://cmr.asm.org/content/21/2/305.full

"The spectrum of illnesses associated with cavitary lung lesions is also broad among persons with immunosuppression due to malignancy or transplantation, but some specific illnesses are considerably more common in this population than in persons infected with human immunodeficiency virus. Patients who have received lung transplants frequently have posttransplant pneumonia caused by Pseudomonas, Staphylococcus, mycobacteria, and Aspergillus species, any of which may cause cavities. These infections are particularly common among persons with cystic fibrosis who received a transplant…Aspergillus should always be strongly suspected in the setting of cavitary lesions after transplantation… Invasive aspergillosis frequently occurs in the early posttransplant period, but with current prophylactic antifungal protocols, invasive aspergillosis is increasingly diagnosed in the later posttransplant period. P. jiroveci and Nocardia infections are also relatively common causes of lung infection among patients with hematological malignancy or posttransplantation, but the routine use of trimethoprim-sulfamethoxazole for Pneumocystis prophylaxis and the prevention of cytomegalovirus disease (a disease that increases the risk for other infectious complications) have significantly reduced the frequency of Pneumocystis and Nocardia lung infection in these patient populations. Of course, many of the pathogens discussed in this review can present as cavitary lesions in patients with hematological malignancy or transplants, so aggressive microbiological sampling, including tissue specimens, where possible, and appropriate testing (e.g., culturing for fungi and mycobacteria) are essential."