Sapovirus-Associated Diarrhea in Renal Transplant Patient Treated Without Altering Immunosuppression

Solid organ transplant (SOT) recipients are at increased risk of infective diarrheas. In such patients, diarrhea can be complicated by dehydration, leading to acute kidney injury or vascular thrombosis. Viral diarrhea in SOT is reported to be commonly due to cytomegalovirus and norovirus. As sapovirus is not routinely included in diagnostic evaluations, its epidemiology and natural history is not well documented. Anecdotal cases of sapovirus-associated diarrhea in renal transplant recipients have been treated with oral nitazoxanide, often with simultaneous reduction in immunosuppressants. We report sapovirus-associated diarrhea in a renal transplant recipient which responded well within two days to oral nitazoxanide. This, possibly, is the first such report from the Indian subcontinent of adequate control of sapovirus-associated diarrhea without any alteration in the immunosuppressant medications.