Cytomegalovirus ischemic colitis and transverse myelitis in a renal transplant recipient

Abstract

We report a rare case of cytomegalovirus (CMV)-associated ischemic colitis and transverse myelitis (TM) occurring precociously after renal transplantation. A 57-year-old male was transplanted with a cadaveric kidney on 5 June 2009. The patient was CMV seropositive and the donor was seronegative. Transplantation was followed shortly by TM, which resulted in paraplegia. The results of magnetic resonance imaging of the spinal cord showed abnormalities. Twenty days after transplantation, he developed abdominal pain with melena and was diagnosed as having CMV-associated ischemic colitis confirmed by colonoscopy and biopsy. Serological data and identification of the viral genome by polymerase chain reaction were confirmatory for CMV. Treatment consisted of intravenous ganciclovir, followed by polyvalent immunoglobulin. The outcome was favorable. Symptomatic CMV infection is relatively common among the renal transplant population. Early colonoscopy is beneficial for making a quick diagnosis and therefore helps to institute a prompt management of CMV colitis. Myelitis is less common in transplant recipients and diagnosis, therefore, was more difficult.

Cytomegalovirus (CMV): associated ischemic colitis in an immunocompetent patient

“…The most frequent gastrointestinal sites of CMV disease affliction in immunocompetent patients are the colon and the rectum (1)(2)(3)(4)(5). The symptoms of CMV colitis are variable (1)(2)(3)(4)(5). The diagnosis is based on complete colonoscopy and colonic biopsies.…”

Cytomegalovirus Colitis in Immunocompetent Patients

“…However, the colon is the most frequent site in immunocompetent patients [5]. CMV colitis clinically presents with a low-grade fever, weight loss, anorexia, malaise, and abdominal pain [6]. Furthermore, watery diarrhea and hematochezia are other common manifestations.…”

“…Furthermore, watery diarrhea and hematochezia are other common manifestations. Mucosal hemorrhage and perforation can be designated as life-threatening complications of CMV colitis [6]. …”

“…Diagnosis of CMV colitis requires both serologic and histologic findings [6]. Immunohistochemistry of the biopsied tissue using monoclonal antibodies and in situ DNA hybridization enhances the sensitivity of the histopathologic analysis [8].…”

Conservative treatment of cytomegalovirus colitis with bowel perforation in an immunocompetent patient: case report and review of literature

“…Infection is usually asymptomatic but can produce symptoms similar to those of infectious mononucleosis, including fever, myalgias, cervical lymphadenopathy, and elevated liver enzyme [7]. However immune compromised hosts, such as those undergoing chemotherapy, transplant or whose with acquired immunodeficiency syndrome, appear to present with more severe symptoms [8,9]. Some studies have also reported an increased risk of CMV-related morbidity and mortality in immunocompromised, critically ill patients [10].…”