title: Ureteritis and cholecystitis: two unusual manifestations of cytomegalovirus disease in renal transplant recipients.
abstract: BACKGROUND
  Common clinical manifestations of cytomegalovirus (CMV) infection include flu-like symptoms with fever, diarrhea, leukopenia, and elevated liver enzymes. Diagnosis is made by detection of the virus by buffy-coat blood culture or by polymerase chain reaction (PCR) analysis.
  
  
  METHODS
  Here we describe two renal transplant recipients who presented with unusual manifestations of CMV disease (cholecystitis and ureteritis). In both patients, no symptoms or signs of systemic CMV infection were present, and they were thought to have other common causes for cholecystitis and ureteral obstruction.
  
  
  RESULTS
  Retrospective analysis of peripheral blood by PCR analysis was positive for CMV DNA. Histologic examination of the resected gall bladder and stenotic ureteric segment showed CMV inclusions, confirmed subsequently by in situ hybridization. Thus, we report that CMV infection may present with acute cholecystitis or ureteral obstruction without its classical clinical symptoms.
  
  
  CONCLUSIONS
  Because CMV infection is common in transplant patients, the atypical manifestations of CMV should be considered in the differential diagnosis of posttransplant complications. Detection of CMV DNA in the peripheral blood by PCR analysis may help identify these patients.
authors.affiliation: Department of Pediatrics, Steven Spielberg Pediatric Research Center, Los Angeles, California 90048, USA.
authors.forename: A
authors.initials: A
authors.lastname: Moudgil
authors.forename: B M
authors.initials: BM
authors.lastname: Germain
authors.forename: C C
authors.initials: CC
authors.lastname: Nast
authors.forename: M
authors.initials: M
authors.lastname: Toyoda
authors.forename: F G
authors.initials: FG
authors.lastname: Strauss
authors.forename: S C
authors.initials: SC
authors.lastname: Jordan
mesh_terms: D000328:Adult; D002763:Cholecystectomy; D002764:Cholecystitis / Q000175:diagnosis* / Q000821:virology; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D014513:Ureter / Q000473:pathology / Q000821:virology; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral