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Unusual presentation of cytomegalovirus enteritis after liver and kidney transplantation

M Alhyraba1, S A Grim, E Benedetti

  • 1Department of Internal Medicine, Section of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois 60612, USA.

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|September 14, 2007
PubMed

Insights

Cytomegalovirus (CMV) infection can be serious in transplant patients. This case highlights an unusual presentation of CMV enteritis causing severe watery diarrhea and shock, emphasizing atypical opportunistic infections in immunosuppressed individuals.

Area of Science:

  • Transplant medicine
  • Infectious diseases
  • Gastroenterology

Background:

  • Cytomegalovirus (CMV) is a common opportunistic infection in solid organ transplant (SOT) recipients, contributing significantly to morbidity and mortality.
  • Gastrointestinal (GI) CMV infections in SOT recipients typically present with fever, abdominal pain, nausea, and bloody diarrhea, often with visible erosive lesions on endoscopy.

Observation:

  • This report details an atypical case of CMV enteritis in a combined kidney and liver transplant recipient.
  • The patient presented with acute, voluminous watery diarrhea as the primary symptom, lacking other typical CMV GI infection indicators.

Findings:

  • The patient rapidly progressed to hypovolemic shock and acute renal failure due to the severe, atypical diarrhea.
  • This presentation underscores the potential for unusual manifestations of CMV enteritis in immunosuppressed populations.

Implications:

  • Clinicians should consider atypical presentations of opportunistic infections like CMV enteritis in transplant recipients, even without classic symptoms.
  • Early recognition and management of such atypical cases are crucial to prevent severe complications like shock and organ failure.
  • This case highlights the importance of vigilance for opportunistic infections in immunocompromised patients, emphasizing diverse clinical presentations.

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