Successful Treatment of Massive Lower Gastrointestinal Bleeding Caused by Mixed Infection of Cytomegalovirus and Mucormycosis in a Renal Transplant Recipient

Abstract

We describe a case of lower gastrointestinal bleeding due to mixed infection of cytomegalovirus (CMV) and mucormycosis in a renal transplant recipient. A 33-year-old male received renal transplantation and his clinical course was uneventful. On the 18th postoperative day, acute rejection was developed and this was treated with high-dose methylprednisolone and OKT3. During antirejection treatment, sudden onset massive hematochezia was developed. Emergency colonofibroscopy revealed multiple colonic ulcers and pathologic findings were consistent with mucormycosis and CMV infection. The patient was successfully treated with amphotericin B (1.0–1.5 mg/kg) and ganciclovir (62.5–125 mg/day) for 5 weeks. To our knowledge, this is the first report showing coexistence of mucormycosis and CMV in the colon ulcer base. This finding suggests that CMV infection may trigger fungal infection in the pathogenesis of colonic ulcer.

A case of cytomegalovirus colitis in an immunocompetent hemodialysis patient

“…Cytomegalovirus (CMV) colitis is a common cause of life‐threatening opportunistic viral infection, especially in immunocompromised patients such as transplant recipients and HIV‐infected patients 1–4 . Cytomegalovirus infections are generally asymptomatic in healthy adults, but CMV infection in immunocompromised host has very serious and fatal clinical outcomes 5 …”

Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding

“…One was caused by a mixed infection of mucormycosis with cytomegalovirus in a renal transplant patient [11]. Anand et al, [6] reported a similar case of bleeding from colonic mucormycosis from our institution.…”

Gastrointestinal Zygomycosis Complicating Heart and Lung Transplantation in a Patient with Eisenmenger’s Syndrome

“…Direct penetration and growth through the blood vessel wall explain the propensity for thrombosis and tissue necrosis, the two major hallmarks of this disease (1). The risk factors associated with zygomycosis are diabetes with acidosis, immunocompromised status, renal failure, recent gastrointestinal surgeries, intraoperative blood transfusions, bacterial infection with prolonged antibiotic therapy, and cytomegalovirus infection (1,(4)(5)(6). There is enough evidence to suggest that in patients with chronic renal failure requiring dialysis, deferoxamine therapy may be an important corisk factor, as Zygomycetes are able to utilize iron bound to iron chelators to enhance their growth (6,7).…”