Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation
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Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.
Abstract
Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.
참고문헌 (17)
- Pouteil-Noble C, "Cytomegalovirus infection—an etiological factor for rejection? A prospective study in 242 renal transplant patients", Transplantation, 55, pp.851~857 (1993)
- Bock GH, "Cytomegalovirus infections following renal transplantation—effects of antiviral prophylaxis: A report of the North American Pediatric Renal Transplant Cooperative Study", Pediatric Nephrol, 11, pp.665~671 (1997)
- Robinson LG, "Predictors of cytomegalovirus disease among pediatric transplant recipients within one year of renal transplantation", Pediatr Transplant, 6, pp.111~118 (2002)
- Wolf DG, "Early diagnosis of human cytomegalovirus disease in transplant recipient by DNA amplification in plasma", Transplantation, 56, pp.330~334 (1993)
- Fisher L, "Antigenemia, immunoblotting, and enzyme immunoassay for early diagnosis of cytomegalovirus infection in renal transplant patients", Transpl Int, 6, pp.201~205 (1993)
- Komorowski RA, "Gastrointestinal complications in renal transplant recipients", Am J Clin Pathol, 86, pp.161~167 (1986)
- Mathew TH, "long-term, randomized multicenter study of mycophenolate mofetil in cadavaric renal transplantation: results at three years. Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group", Transplantation, 65, pp.1450~1454 (1998)
- Sarmiento JM, "Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients", Clin Transplant, 14, pp.136~138 (2000)
- ter Meulen CG, "The influence of mycophenolate mofetil on the incidence and severity of primary cytomegalovirus infections and disease after renal transplantation", Nephrol Dial Transplant, 15, pp.711~714 (2000)
- Abbott KC, "Hospitalization for cytomegalovirus disease after renal transplantation in the United States", Ann Epidemiol, 12, pp.402~409 (2002)
- Zylber-Katz E, "Abrupt increase of Tacrolimus blood levels during an episode of Shigella infection in a child after liver transplantation", Ther Drug Monit, 23, pp.647~649 (2001)
- Hochleitner BW, "Increased tacrolimus levels during diarrhea", Transpl Int, 14, pp.230~233 (2001)
- Slifkin M, "Late and atypical cytomegalovirus disease in solid-organ transplant recipients", Clin Infect Dis, 33, pp.E62~E68 (2001)
- Snydman DR, "Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal transplant recipients", N Engl J Med, 317, pp.1049~1054 (1987)
- Tanaka Y, "Monitoring cytomegalovirus infection by antigenemia assay and two distinct plasma real-time PCR methods after hematopoietic stem cell transplantation", Bone Marrow Transplant, 30, pp.315~319 (2002)
- Griscelli F, "Quantitation of human cytomegalovirus DNA in bone marrow transplant recipient by real-time PCR", J Clin Microbiol, 39, pp.4362~4369 (2001)
- Jassal SV, "Clinical practice guidelines: prevention of cytomegalovirus disease after renal transplantation", J Am Soc Nephrol, 9, pp.1697~1708 (1998)
