Cytomegalovirus maculopapular eruption in a kidney transplant patient

Abstract

Cytomegalovirus (CMV) is the most important viral agent in kidney transplantation. Clinical manifestations of CMV disease in transplantation include hepatitis, pneumonitis, pancreatitis, kidney allograft dysfunction, colitis, and meningoencephalitis. However, skin involvement is rare. We describe a severely compromised cadaveric-kidney transplant recipient who developed renal failure, colonic ulcers, and a maculopapular rash accompanied by fever and malaise 4 months after transplantation. Only the skin biopsy was diagnostic and consistent with CMV disease. Intravenous ganciclovir administration resulted in clinical improvement of CMV-induced skin lesions; kidney function normalized and the patient became asymptomatic after 14 days of ganciclovir therapy. Nephrologists should consider the diagnosis of CMV disease in the febrile immunosuppressed patient with skin involvement. Skin biopsy must be considered as a useful and safe procedure in patients with a rash to obtain a prompt diagnosis and efficiently treat this immunocompromised population.

Late-Onset Cytomegalovirus-Associated Interstitial Nephritis in a Kidney Transplant

“…Our patient had chronic CMV disease, which occur in 10% of CMV previous acute episodes [9]: He had a history of a flu-like syndrome, probable CMV colitis and biopsy-proven CMV skin disease four months posttransplant [7]. After appropriate treatment, CMV recurred 18 months posttransplantation, showing that CMV must be considered as a possible cause of graft dysfunction beyond the classical time-frame of 1 to 6 months posttransplant.…”

“…A 57-year-old Japanese man with a cadaveric kidney transplant (D+/R+) developed renal failure 18 months posttransplant [7]. The patient received intravenous ganciclovir for the first 14 days posttransplant and then oral ganciclovir for 3 months.…”

“…The most likely clinical presentation is a flu-like picture. Other documented clinical manifestations include pneumonia, liver dysfunction, pancreatitis, colonic or esophageal ulcers, meningoencephalitis, and rarely myocarditis, chorioretinitis and skin involvement [5, 6, 7]. …”

Rare Presentations of Cytomegalovirus Infection in Renal Allograft Recipients

“…It should be considered when multiple anogenital, axillary, scrotal, and penile ulcers appear in an immune-compromised individual and are not responding to conventional antibiotic therapy (37). Painful ulceration of the tongue was reported as one manifestation of CMV infection in two renal-transplant patients.…”

A potential role for cytomegalovirus in a facial ulcer in a renal transplant recipient

“…In addition to the involvement of organs, CMV may present with non‐specific clinical symptoms such as fever, fatigue, and weakness . Involvement of the skin has been rarely reported . Herein, we present a case of CMV infection manifested as an ulcerative skin lesion on the face diagnosed by biopsy, which resolved following antiviral treatment.…”