title: Cytomegalovirus and Clostridium difficile ischemic colitis in a renal transplant recipient: a lethal complication of anti-rejection therapy?
abstract: Intestinal ischemia is reported to be the most common gastrointestinal complication of renal transplantation and a potential cause of morbidity and mortality. The recent use of more potent immunosuppressive drug regimens has reduced the incidence of acute rejection, increasing the incidence of potentially fatal infectious complications, such as clinically important cytomegalovirus (CMV) infection. A 42-year-old kidney transplant recipient experienced on postoperative day 10 a dehiscence of the ureterovesical anastomosis, associated with a 7-cm longitudinal tear graft on the lower pole of the kidney and an ureteral ischemia. A graft biopsy demonstrated a mild acute rejection for which the patient received an unsuccessful administration of steroids, with progression of the rejection, so that 1 mg/kg/day antithymocyte globulin was administered. Two days later the patient presented with fever (39.5 degrees C), diffuse abdominal pain with tenderness and bloody diarrhea, and diagnosis of CMV colitis was achieved; rectal samples were taken for histologic examination, and Clostridium difficile toxin was isolated. A subtotal colectomy with Hartmann's procedure was performed, but the patient died 13 days later of a multiple organ failure. The risk of lethal CMV colitis is increased in patients being treated with anti-rejection therapy for severe acute rejection; the occurrence of simultaneous infection, such as pseudomembranous colitis, usually characterized by a favorable prognosis, increases the mortality rate in these patients.
authors.affiliation: Department of Surgery, Transplantation and Advanced Technologies, Organ Transplant Unit, University Hospital of Catania, Catania, Italy. veroux@unict.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
authors.forename: Lidia
authors.initials: L
authors.lastname: Puzzo
authors.forename: Daniela
authors.initials: D
authors.lastname: Corona
authors.forename: Antonino
authors.initials: A
authors.lastname: Buffone
authors.forename: Tiziano
authors.initials: T
authors.lastname: Tallarita
authors.forename: Paolo
authors.initials: P
authors.lastname: Murabito
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Veroux
mesh_terms: D000328:Adult; D016360:Clostridioides difficile; D017091:Colitis, Ischemic / Q000209:etiology; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000209:etiology*; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation
chemical_list: D007166:Immunosuppressive Agents