title: Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient.
abstract: Cytomegalovirus (CMV) is an important pathogen in organ-transplant recipients. There have been frequent reports of CMV-induced adrenal insufficiency in patients with human immunodeficiency virus infection. Herein, we report CMV-induced renal insufficiency in a renal transplant recipient. A 24-year-old woman had gradual onset of weakness, anorexia, nausea, hypotension, and skin hyperpigmentation at 5 months after renal transplantation. The immunosuppression regimen included cyclosporine, mycophenolate mofetil, and corticosteroid (prednisolone, 5 mg/d). Recent history included acute CMV infection, which was treated with ganciclovir. Basal serum cortisol concentration was 4 microg/dL, and stimulated serum cortisol concentration was less than 10 microg/dL. All clinical signs and symptoms and hypotension gradually improved after the oral prednisolone dose was increased to 10 mg/d. Clinicians must be aware of the possibility of CMV-induced adrenal insufficiency in renal transplant recipients. The condition may be symptomatic despite low-dose prednisolone therapy.
authors.affiliation: Nephrology Department, Tabriz University of Medical Sciences, Tabriz, Iran. ardalan34@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Ardalan
authors.forename: M M
authors.initials: MM
authors.lastname: Shoja
mesh_terms: D000309:Adrenal Insufficiency / Q000821:virology*; D000914:Antibodies, Viral / Q000097:blood; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000821:virology; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D011239:Prednisolone; D003404:Creatinine; D006854:Hydrocortisone