CMV-associated adrenal insufficiency in a renal transplant recipient

Abstract

Adrenal insufficiency is a rare manifestation of tissue-invasive cytomegalovirus (CMV) disease. CMV is one of the leading opportunistic pathogens affecting renal transplant recipients. Its prevalence in the adrenal glands of autopsied AIDS cases has been well documented. We report a rare case of CMV-associated adrenal insufficiency in a renal transplant recipient.

Cytomegalovirus adrenalitis mimicking adrenal metastasis in an immunocompetent patient

“…Outside of concurrent AIDS, CMV-associated adrenalitis has been described in two case reports of renal transplant recipients [ 6 , 7 ]. In both case reports, the donors were positive for anti-CMV IgG antibodies.…”

Bilateral cytomegalovirus infection of the adrenal glands revealed by 18F‐FDG PET/CT in a patient with T‐cell lymphoma

“…As already described in the literature, the tissue‐invasive CMV disease can affect any organ or system and the most frequent clinical manifestations are gastrointestinal disease, pneumonia, hepatitis, central nervous system disease, retinitis, nephritis, pancreatitis, and myocarditis 10 . CMV adrenalitis has been mainly described in patients with acquired immune deficiency syndrome (AIDS) 11 . Pulakhandam et al 12 demonstrated that, after reviewing the autopsy of 74 patients with AIDS, 50% had CMV infection among which 84% had adrenalitis; they concluded that the adrenal gland is the most frequently affected organ in AIDS with CMV infection.…”

The potential role for infections in the pathogenesis of autoimmune Addison’s disease

“…Other studies have reported that the adrenal gland is the most frequently CMV‐affected organ in AIDS patients . CMV and adrenalitis have also been described in other acquired immunodeficient states, such as allogeneic haematopoetic stem‐cell transplantation, kidney transplantation and liver transplantation after chronic hepatitis C virus infection . Finally, adrenal infections by CMV and also other members of the Herpesviridae family, such as herpes simplex virus types 1 and 2 (HSV‐1/HSV‐2) and human herpesvirus 6 (HHV‐6), have been reported in neonates and infants .…”