HDCN Article Review/Hyperlink

Gregor PJHS, van Gelder T, Tanis AA, Chadha-Ajwani S, Klaassen RJL, Weimar W

Case report. Cytomegalovirus colitis in a CMV-seropositive renal transplant recipient on triple drug therapy including mycophenolate)

Nephrol Dial Transplant (Dec) 12:2766-2767 1997

There is no abstract available for this case report. I chose it given the recent enthusiasm for treating refractory lupus nephritis with mycophenolate mofetil (see ASN abstracts, 1997, although these particular abstract reviews may not yet be posted). An increased incidence of CMV infection in renal transplant patients treated with MMF is well known, and usually is controlled by adding prophylactic ganciclovir. CMV colitis, common in AIDS patients, has been unusual in the renal transplant population. In this case 1 month after transplantation usint Csa, prednisone, and MMF as immunotherapy (without induction), a patient presented with malaise and spiking fever. Although CMV serology, including IgM were negative, he was placed on IV ganciclovir, with resolution of fever. Ganciclovir was stopped, and once off ganciclovir for 2 days, the patient developed fever with bloody diarrhea and diffuse abdominal pain. Pathologic examination of colon biopsies was consistent with CMV colitis. The disease responded to therapy with oral ganciclovir.

Comment: An interesting part of this case was the lack of serologic evidence for CMV infection, including negative plasma anti-CMV IgM levels. (John T. Daugirdas, M.D., University of Illinois at Chicago)