[Remission of severe disease induced by CMV and lymphoproliferative post-transplant disease after changing the immunosuppressive regime].
We describe a renal transplant recipient, with overimmunosuppression induced by the interaction of tacrolimus and fluconazole, who developed two severe diseases produced by two different viruses of the herpes group (cytomegalovirus [CMV] disease and posttransplant lymphoproliferative [PTLD] disease EBV-related). Detection of Epstein-Barr virus (EBV) DNA in the blood preceded the histological diagnosis of PTLD. Both diseases improved after changes in the immunosuppressive regime and treatment with ganciclovir. Because CMV infection is a risk factor in developing PTLD, and the clinical and endoscopic manifestations of both diseases could be become confused, PTLD should be excluded in EBV seronegative patients that develop CMV disease. The detection of the EBV genome in blood could help in the early diagnosis of PTLD in these patients.
Gómez
E
E
Servicio de Nefrología Hospital Central de Asturias Celestino Villamil, s/n. 33006 Oviedo. egomezh@hcas.insalud.es
Melón
S
S
Fresno
M F
MF
Tricas
L
L
Navascués
R
R
de Oña
M
M
Herreros
M
M
Alvarez Grande
J
J
D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy* / Q000209:etiology; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use
D000998:Antiviral Agents; D015725:Fluconazole; D015774:Ganciclovir; D016559:Tacrolimus