Gastric ulcer despite no acid in a renal allograft recipient: what is the link?

Abstract

A 33-year-old female patient with end-stage renal disease underwent successful cadaveric renal transplantation in February 2005. The patient's immunosuppressive regimen comprised thymoglobulin (ATG Fresenius AG, Germany) 100 mg/day for induction, corticosteroid (methylprednisolone 500 mg/day for 3 days and followed by oral prednisolone 1 mg/kg/day), mycophenolic acid (MPA) (Myfortic, Novartis Pharma Stein A.G., Switzerland) 1440 mg/day. The cytomegalovirus (CMV) status of the patient was seronegative (RÀ), whilst it was seropositive for donor (Dþ). The allograft immediately functioned, and serum creatinine levels decreased to 0.9 mg/dl. Tacrolimus was initiated at a dose of 0.1 mg/kg/day 3 days after the operation, and thymoglobulin was used for 5 days. The tacrolimus dose was titrated based on trough levels. Trimetoprimsulphametoxozole, flucanozole and acyclovir were given for prophylactic therapy. Omeprazole was also given for gastroduodenal protection. There were no postoperative complications, and the patient was discharged 9 days after the operation.The patient was readmitted to the hospital 6 weeks after the transplantation, because of nausea, vomiting, severe malaise and abdominal pain. On physical examination, the patient was afebrile and haemodynamically stable. The abdomen was flat and soft with minimal epigastric tenderness. The remainder of the examination was unremarkable. Initial laboratory data showed a haemoglobin level of 11.2 g/dl, total white blood cell count of 6300/mm 3 and platelet count of 165.000/mm 3 . A chest X-ray showed clear lung fields. Serum electrolytes, blood urea nitrogen and creatinine were normal. The serum ALT level was

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

“…Cyclosporin 15,22,27,28,[30][31][32]38,41,46,54,56,58,60,64,68,[70][71][72][73][74] 34 MMF 15,16,22,[24][25][26][27][28]30,31,36,40,41,43,45,50,51,[54][55][56]57,59,61,62,65,70,72,74 85 Azathioprine Colitis [14][15][16][17]…”