Late cytomegalovirus disease with atypical presentation in renal transplant patients: Case reports

Boobes, Y.; Hakim, M. Al; Dastoor, Hormaz; Bernieh, Bassam; Abdulkhalik, Samar

doi:10.1016/j.transproceed.2004.07.017

Cited by 14 publications

(10 citation statements)

References 9 publications

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“…We also found that tissue-invasive CMV disease had a greater association with death than CMV disease with no evidence for tissue invasion. It has been reported that delayed-onset CMV disease presents atypically (20) and may not be recognized until it has resulted in tissue-invasion. It is possible that severe tissue-invasive CMV disease contributes to the causal pathway for death.…”

Section: Discussionmentioning

confidence: 99%

“…One study reported that late-onset CMV disease was associated with an almost 3-fold increased risk of allograft loss or death (16), while another study did not demonstrate an association with death or graft loss (18). Very late-onset CMV disease is even less well-characterized, but has been reported to present atypically (20), and has been associated with an increased risk of death compared to late-onset CMV disease in a small case-control study (21). …”

Section: Introductionmentioning

confidence: 99%

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Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

et al. 2014

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Background Use of prophylactic anti-CMV therapy for 3 to 6 months after kidney transplantation can result in delayed-onset CMV disease. We hypothesized that delayed-onset CMV disease (occurring ≥ 100 days post-transplant) occurs more commonly than early-onset CMV disease, and that it is associated with death. Methods We assembled a retrospective cohort of 15,848 adult kidney transplant recipients using 2004 to 2010 administrative data from the California and Florida Healthcare Cost and Utilization Project State Inpatient Databases. We identified demographic data, comorbidities, CMV disease coded during readmission and inpatient death. We used multivariate Cox proportional hazards modeling to determine risk factors for delayed-onset CMV disease and inpatient death. Results Delayed-onset CMV disease was identified in 4.0% and early-onset CMV disease was identified in 1.2% of the kidney transplant recipients. Risk factors for delayed-onset CMV disease included previous transplant failure or rejection (HR 1.4) and residence in the lowest-income ZIP codes (HR 1.2). Inpatient death was associated with CMV disease occurring 101–365 days post-transplant (HR 1.5), CMV disease occurring > 365 days post-transplant (HR 2.1), increasing age (by decade: HR 1.5), non-white race (HR 1.2), residence in the lowest-income ZIP codes (HR 1.2), transplant failure or rejection (HR 3.2), prior solid organ transplant (HR 1.7) and several comorbidities. Conclusions These data showed that delayed-onset CMV disease occurred more commonly than early-onset CMV disease, and that transplant failure or rejection is a risk factor for delayed-onset CMV disease. Further research should be done to determine if delayed-onset CMV disease is independently associated with death.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

et al. 2014

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“…In immunocompromised subjects, however, CMV infection can present as asymptomatic viremia or CMV syndrome with viremia and symptoms including fever and malaise, or even as tissue‐invasive disease, such as colitis, hepatitis, pneumonitis, myocarditis, meningoencephalitis, and rarely retinitis, . Involvement of the gastrointestinal (GI) tract is a relatively common manifestation of tissue‐invasive CMV disease . CMV disease or reactivation of latent virus is a cause of significant morbidity after solid organ transplantation, including kidney transplantation, that can adversely affect transplantation outcome increasing the risk of rejection episodes and, in complicated cases, affect patient survival .…”

Section: Discussionmentioning

confidence: 99%

Small bowel obstruction caused by inflammatory cytomegalovirus tumor in a renal transplant recipient: report of a rare case and review of the literature

Papadimitriou

Koukoulaki

Vardas

et al. 2012

Transplant Infectious Dis

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Cytomegalovirus (CMV) infection in renal transplant recipients can present as asymptomatic viremia or CMV syndrome or, in more severe cases, as tissue-invasive disease. CMV enteritis, a common manifestation of CMV invasive disease, usually presents with fever, abdominal pain, anorexia, nausea, and diarrhea, and can be rarely complicated by colon perforation, hemorrhage, or megacolon. CMV infection occurs primarily in the first 6 months post transplantation, when immunosuppression is more intense. We describe the case of a female renal transplant recipient with small bowel obstruction caused by CMV disease 7 years post renal transplantation. The patient presented with diarrhea and abdominal pain. Because of elevated CMV viral load, she was initially treated with antiviral therapy with transient response. Endoscopy and imaging tests showed obstruction of the terminal ileum and, subsequently, the patient underwent exploratory laparotomy when a right hemicolectomy was performed. Biopsy results confirmed the diagnosis of CMV enteritis. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options, and morbidity-mortality rates of CMV infection/disease, in renal transplant recipients, are reviewed.

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“…The importance of this type of atypical presentation is that clinicians must be aware of the hazards of CMV infection in immunocompromised patients, even with an unusual presentation [3,4]. We conclude that the possibility of CMV disease should be explored in all kidney transplant patients within the first 6 months posttransplantation because massive immunosuppressive therapy for the prevention of graft rejection increases the risk for CMV infection.…”

mentioning

confidence: 99%

Cytomegalovirus esophagitis presents as chest pain in a renal transplant recipient

Joo

Jung

Baeg

et al. 2013

Korean J Intern Med

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Late cytomegalovirus disease with atypical presentation in renal transplant patients: Case reports

Cited by 14 publications

References 9 publications

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

Delayed-Onset Cytomegalovirus Disease Coded During Hospital Readmission After Kidney Transplantation

Small bowel obstruction caused by inflammatory cytomegalovirus tumor in a renal transplant recipient: report of a rare case and review of the literature

Cytomegalovirus esophagitis presents as chest pain in a renal transplant recipient

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