Late and atypical cytomegalovirus disease in solid-organ transplant recipients

Area of Science:

• Transplant Medicine
• Infectious Diseases
• Virology

Background:

• Cytomegalovirus (CMV) disease commonly affects solid-organ transplant recipients 1-4 months post-transplant, typically presenting with fever and leukopenia.
• Established case definitions for CMV disease focus on early post-transplant presentations.

Observation:

• Five cases of late and atypical CMV disease were observed in heart, liver, and kidney transplant recipients between 6 months and 22 years post-transplant.
• Atypical features included absence of fever (3/5), elevated white blood cell counts (4/5), and normal platelet counts (4/5).
• Some patients had pulmonary CMV disease without hypoxia or chronic enterocolitis.

Findings:

• These late presentations occurred despite some patients receiving ganciclovir prophylaxis or being treated for rejection.
• The observed cases challenge the typical understanding of CMV disease timing and clinical manifestations.
• Risk factors included primary CMV infection and specific immunosuppressive therapies like muromonab-CD3.

Implications:

• The findings suggest a potential evolution in the epidemiology and clinical spectrum of CMV disease in transplant recipients.
• This necessitates re-evaluation of diagnostic criteria and monitoring strategies for CMV in the late post-transplant period.
• Changes in immunosuppression protocols and early CMV prevention may be influencing these atypical presentations.