title: Late and atypical cytomegalovirus disease in solid-organ transplant recipients.
abstract: Posttransplantation cytomegalovirus (CMV) disease typically occurs 1-4 months after solid-organ transplantation. The case definition invariably includes unexplained fever for > or =3 days, often with leukopenia. Late and atypical presentation of CMV disease has been rarely reported. Five cases of late and atypical CMV disease in heart (n = 1), liver (n = 1), and kidney (n = 3) transplant recipients occurred within a 4-month period in early 1999. These patients presented at a median of 25 months after organ transplantation (range, 6 months to 22 years). Atypical findings included absence of fever in 3 patients, elevated white blood cell counts in 4 patients, and normal platelet counts in 4 patients. Four patients were at risk for primary CMV infection, and 3 received ganciclovir prophylaxis for 3 months. One patients was treated for rejection, and 2 patients had induction muromonab-CD3 (Orthclone; Orthobiotech). Two of the patients had pulmonary CMV disease, but neither of these patients had hypoxia. Two patients had enterocolitis, one of whom had chronic colitis for a year. These cases may represent a changing epidemiology and clinical presentation of CMV disease in solid-organ transplant recipients in an era of changing immunosuppression and improved CMV disease prevention in the early posttransplantation period.
authors.affiliation: Department of Geographic Medicine and Infectious Diseases, New England Medical Center and Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: M
authors.initials: M
authors.lastname: Slifkin
authors.forename: P
authors.initials: P
authors.lastname: Tempesti
authors.forename: D D
authors.initials: DD
authors.lastname: Poutsiaka
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000328:Adult; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000503:physiopathology* / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D013997:Time Factors