Unusual presentation of cytomegalovirus infection in patients after organ transplant.
OBJECTIVE
Cytomegalovirus (CMV) infection has an enormous impact in solid-organ transplant patients. In immunocompromised patients, CMV is associated with well-known direct effects. We herein describe 3 unusual patterns occurring in the setting of tissue-invasive CMV associated with high viral load.


METHODS
Of our 3 cases, the first patient after kidney transplant presented with cholestasis related to radiological cholangitis; the second patient after heart transplant presented with erythema nodosum with CMV infection as the sole cause; and the third patient after kidney transplant presented with acute renal failure related to mild interstitial nephritis with acute tubular necrosis and tubulitis.


RESULTS
The first patient's cholestasis resolved with antiviral therapy, as did the erythema nodosum and CMV infection of the heart transplant patient. The third patient's acute renal failure resolved by increased steroid dosage, plasma exchanges, and ganciclovir therapy.


CONCLUSIONS
These 3 unusual presentations of tissue invasive CMV had favorable outcomes with antiviral therapy.
Tiple
Aurelien
A
Department of Nephrology, Dialysis, and Multiorgan Transplantation, University Hospital, CHU RANGUEIL, 1 av. J. Poulhes, TSA 50032, 31059 Toulouse Cedex 9, France.
Kamar
Nassim
N
Esposito
Laure
L
Mengelle
Catherine
C
Combelles
Sophie
S
Otal
Philippe
P
Celine Guilbeau-Frugier
Celine
C
Rostaing
Lionel
L
D058186:Acute Kidney Injury / Q000628:therapy / Q000821:virology*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002761:Cholangitis / Q000188:drug therapy / Q000821:virology*; D002779:Cholestasis / Q000188:drug therapy / Q000821:virology*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D004893:Erythema Nodosum / Q000188:drug therapy / Q000821:virology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D016896:Treatment Outcome; D055815:Young Adult
D000998:Antiviral Agents; D007166:Immunosuppressive Agents