Colitis in a renal transplant patient with human herpesvirus‐6 infection

Abstract

A male patient developed colitis and a thrombotic microangiopathy 3 weeks after renal transplantation. Immunosuppression at the time of presentation was with sirolimus, mycophenolate mofetil, and prednisolone, but without a calcineurin inhibitor. Cytomegalovirus infection was excluded. However, human herpesvirus-6 DNA was detected at high copy number in both blood and colonic epithelium. The patient recovered after reduction in immunosuppression, with nutritional support and ganciclovir therapy.

HHV-6B is frequently found in the gastrointestinal tract in kidney transplantation patients

“…In stem cell transplant patients with gastrointestinal symptoms, HHV‐6 DNA has been detected by PCR in gastroduodenal and colorectal mucosa [8] and by in situ hybridization in large bowel mucosa [9]. Occasional case reports have described HHV‐6 associated colitis in lung and renal transplant recipients [10–12].…”

Case Report: Human herpesvirus 6 reactivation associated with colitis in a lung transplant recipient

“…While diarrhea is frequent in patients undergoing stem cell transplantations, HHV-6 was considered a causal agent in very few cases [Amo et al, 2003;Hentrich et al, 2005]. Among solid organ recipients, only one case of a bowel involvement attributed to HHV-6 was reported recently in a kidney transplant patient with fever, diarrhea, and skin rash [Delbridge et al, 2006]. The present report describes a case of colitis associated with HHV-6B reactivation in a lung transplant recipient.…”

“…However, coinfections with other viral agents (Epstein-Barr virus, CMV, HSV, adenovirus) were documented in these cases [Halme et al, 2008]. A case of colitis attributed to HHV-6 was recently described in a renal transplant recipient [Delbridge et al, 2006]. The diagnosis was suggested by high HHV-6 DNA copy number in blood and colonic mucosa after exclusion of CMV infection.…”

Human herpesvirus-6 infections in kidney, liver, lung, and heart transplantation: review

“…Kidney transplant recipients Asymptomatic HHV-6 reactivation in the majority of patients; clinical disease only in an estimated 1% of patients Direct effects: fever, rash, renal dysfunction such as a rise in serum creatinine, hepatitis and liver dysfunction, gastrointestinal symptoms including colitis, hemophagocytosis syndrome, and encephalitis [54,62,63,64,65,66] Indirect effects: Acute and chronic rejection including chronic allograft nephropathy, higher rates of CMV disease [27,30,49,89] Liver transplant recipients Asymptomatic HHV-6 reactivation in the majority of patients; clinical disease occurs in an estimated 1% of patients Direct effects: fever, rash, thrombocytopenia, neurologic abnormality including encephalopathy, hepatitis including giant cell hepatitis, gastrointestinal illness such as dyspepsia, pneumonia [23,26,27,32,36,45,48,52,55,71] Indirect effects: Higher rates of CMV disease, accelerated HCV recurrence, higher rates of invasive fungal diseases [34,60,62,[81][82][83][84][85][86] Heart and lung transplant recipients Incidence is not fully defined, but reactivation is presumed to be mostly asymptomatic Direct effects: Pneumonia, encephalitis, colitis, giant cell hepatitis [43,47,53,76,77] Indirect effects: bronchiolitis obliterans syndrome, higher all-cause mortality [42,73] Notes: HHV-6, human herpesvirus 6; CMV, cytomegalovirus; HCV, hepatitis C virus.…”