title: Spotting the owl: surreptitious cytomegalovirus disease in a renal transplant recipient.
abstract: Cytomegalovirus (CMV) is a known cause of ulcerative oral lesions among HIV-infected patients, but such ulcers have not been previously reported in recipients of solid organ transplants. We describe a case of a renal transplant recipient who developed severe CMV-associated oral lesions despite prophylaxis with valganciclovir, and in the absence of detectable CMV viremia. The diagnosis was made only after multiple biopsies of the lesions. The patient recovered upon reducing immunosuppression. Potential pitfalls in making a prompt diagnosis are reviewed. The differential diagnosis of a large oral ulceration in a transplant recipient is broad, but should include CMV infection.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Tarkan
authors.forename: Sook-Bin
authors.initials: SB
authors.lastname: Woo
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: Scott R
authors.initials: SR
authors.lastname: Johnson
authors.forename: Lucian R
authors.initials: LR
authors.lastname: Chirieac
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Chimienti
authors.forename: Didier A
authors.initials: DA
authors.lastname: Mandelbrot
mesh_terms: D000368:Aged; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods; D016030:Kidney Transplantation; D008297:Male; D019226:Oral Ulcer / Q000175:diagnosis; D011183:Postoperative Complications