27 March 2015 : Case report
Severe Cytomegalovirus Infection in a Second Kidney Transplant Recipient Treated with Ganciclovir, Leflunomide, and Immunoglobulins, with Complications including Seizures, Acute HCV Infection, Drug-Induced Pancytopenia, Diabetes, Cholangitis, and Multi-Organ Failure with Fatal Outcome: A Case ReportDorota Miszewska-SzyszkowskaABCDEF, Natalia MikołajczykA, Ewa Komuda-LeszekB, Renata Wieczorek-GodlewskaB, Robert ŚwiderA, Dominika Dęborska-MaterkowskaDF, Jacek SzmidtABCD, Magdalena DurlikABCDEF
Ann Transplant 2015; 20:169-174
BACKGROUND: Cytomegaly remains one of the most common infectious complications in organ transplant recipients, and the course of the infection may have a negative effect on survival of the transplant and recipient.
CASE REPORT: We describe the case of a 32-year-old female patient who received a second kidney transplant from a cadaveric donor in July 2012, treated successfully with ganciclovir for primary CMV infection in August 2012 and then re-treated from November due to re-infection. The viral load at the start of re-treatment was 6 million copies. In view of ganciclovir treatment failure, Sando immunoglobulins were administered. Subsequently, when CMV viral load increased to 18 million copies, a decision was made to use combination treatment with leflunomide and ganciclovir. Immunosuppressive treatment was also modified by administering everolimus in view of its potential antiviral activity. Seizures, pancytopenia, diabetes, diarrhoea, and (probably) drug-induced liver damage and cholangitis were observed in the course of treatment. At 3 months of hospitalization, the patient was discharged home with viral load of 8000 copies. As treatment continuation, she received valganciclovir at the full therapeutic dose in view of very good kidney function (creatinine 0.7 mg/dl). The patient was re-hospitalized after 10 days due to fever and cough. Due to abnormal liver function test results and negative serum markers of viral hepatitis, HCV RNA was tested, with a positive result (above 10^8 copies). Subsequently, decline in clinical status, overhydration, increasing creatinine levels, hepatic failure signs, and renewed CMV DNA increase to 520 000 copies were observed. Despite intensive treatment, the patient died of multi-organ failure.
CONCLUSIONS: The case described illustrates the difficulties in the treatment of CMV infection and its possible dramatic complications.
Keywords: Cytomegalovirus, Ganciclovir, Immunoglobulins
04 Aug 2022 : Original articleLong-Term Patency of All-in-One Sleeve Patch Graft Venoplasty in 16 Patients Who Underwent Living Donor Liv...
Ann Transplant In Press; DOI: 10.12659/AOT.936888
22 Jul 2022 : Original articleDiagnostic Role of Tumor Markers for Hepatocellular Carcinoma in Liver Transplantation Candidates: An Analy...
Ann Transplant In Press; DOI: 10.12659/AOT.936937
22 Jul 2022 : Original articleDevelopment of a Novel Model for Predicting Postoperative Short-Term Outcome in Patients with Hepatitis B-R...
Ann Transplant In Press; DOI: 10.12659/AOT.936732
Most Viewed Current Articles
26 Jan 2022 : Review articleRecurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models
Ann Transplant 2022; 27:e934924
29 Dec 2021 : Original articleEfficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...
Ann Transplant 2021; 26:e933588
24 Jul 2020 : Review articleKidney Transplantation in the Times of COVID-19 – A Literature Review
Ann Transplant 2020; 25:e925755