title: Cytomegalovirus-induced thrombotic microangiopathy after renal transplant successfully treated with eculizumab: case report and review of the literature.
abstract: De novo thrombotic microangiopathy (TMA) after renal transplant is rare. Cytomegalovirus (CMV)-related post-transplant TMA has only been reported in 6 cases. We report an unusual case of a 75-year-old woman who developed de novo TMA in association with CMV viremia. The recurrence of TMA with CMV viremia, the resolution with treatment for CMV, and the lack of correlation with a calcineurin inhibitor (CNI) in our case support CMV as the cause of the TMA. What is unique is that the use of eculizumab without plasmapheresis led to prompt improvement in renal function. After a failure to identify a genetic cause for TMA and the clear association with CMV, eculizumab was discontinued. This case provides insight into the pathogenesis and novel treatment of de novo TMA, highlights the beneficial effects of complement inhibitors in this disease, and shows that they can be safely discontinued once the inciting etiology is addressed.
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Anuja
authors: A
authors: Java
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Angelina
authors: A
authors: Edwards
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Ana
authors: A
authors: Rossi
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Richa
authors: R
authors: Pandey
authors: Department of Pathology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Joseph
authors: J
authors: Gaut
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Rowena
authors: R
authors: Delos Santos
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Brent
authors: B
authors: Miller
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Christina
authors: C
authors: Klein
authors: Department of Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA.
authors: Daniel
authors: D
authors: Brennan
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000737:chemistry; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D003165:Complement System Proteins; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D012008:Recurrence; D057049:Thrombotic Microangiopathies / Q000150:complications* / Q000821:virology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003165:Complement System Proteins; C481642:eculizumab
keywords: atypical hemolytic uremic syndrome; cytomegalovirus; eculizumab; renal transplant thrombotic microangiopathy