title: Cytomegalovirus infection with perineal pain after living donor liver transplantation: report of four cases.
abstract: We report on 4 adult cases of presumptive cytomegalovirus (CMV) disease with perineal pain after living donor liver transplantation. Patients presented with severe perineal pain without any other symptoms related to CMV infection, except pyrexia. All patients had an episode of acute cellular rejection (ACR) before the onset of perineal pain, and 1 patient needed OKT3 therapy. The severe perineal pain was not well controlled with medication, and 1 patient needed epidural anesthesia. In the first 3 patients, pp65 CMV antigenemia (pp65CMV-Ag) test results were positive and intravenous administration of ganciclovir (GCV) therapy was initiated. In the last patient, GCV therapy was preemptively administered before a positive pp65CMV-Ag test result was confirmed. After administration of GCV, the pain gradually disappeared and all patients had negative pp65CMV-Ag test results. In conclusion, unusual perineal pain can be a symptom related to CMV infection. CMV infection needs to be kept in mind when a liver transplant recipient has severe perineal pain, especially after receiving treatment for ACR.
authors.affiliation: Department of Transplantation & Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan. sseisuke@kuhp.kyoto-u.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Sakamoto
authors.forename: K
authors.initials: K
authors.lastname: Taira
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: Y
authors.initials: Y
authors.lastname: Takada
mesh_terms: D000328:Adult; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005334:Fever / Q000473:pathology; D015774:Ganciclovir / Q000008:administration & dosage*; D006084:Graft Rejection / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007275:Injections, Intravenous; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000473:pathology*; D011183:Postoperative Complications; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents; D015774:Ganciclovir