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Article Review/Hyperlink
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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)
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