title: Prolonged norovirus infection after pancreas transplantation: a case report and review of chronic norovirus.
abstract: Norovirus is a major cause of self-limited gastroenteritis worldwide. Prevention and treatment are thwarted by rapid viral evolution, and thus supportive care remains the mainstay of therapy. Chronic infection in immunocompromised hosts is increasingly described. We report a case of norovirus infection lasting 2543 days in a pancreas transplant recipient. Serial fecal specimens were obtained, from which a map of genetic relatedness was derived. The clinical course was complicated by renal failure that progressed to end-stage renal disease. Minimization of immunosuppression was associated with resolution of the infection. Subsequently, the patient experienced a suspected allograft rejection that did not compromise pancreas function. The patient later underwent living-related renal transplantation without recurrence of enteritis.
authors.affiliation: Division of Infectious Disease, Cleveland Clinic Florida, Weston, Florida, USA.
authors.forename: I A
authors.identifier: http://orcid.org/0000-0002-6301-0121
authors.initials: IA
authors.lastname: Echenique
authors.affiliation: Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: V
authors.initials: V
authors.lastname: Stosor
authors.affiliation: Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: L
authors.initials: L
authors.lastname: Gallon
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kaufman
authors.affiliation: Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago, Illinois, USA.
authors.forename: C
authors.initials: C
authors.lastname: Qi
authors.affiliation: Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Zembower
mesh_terms: D017250:Caliciviridae Infections / Q000150:complications / Q000821:virology*; D002908:Chronic Disease; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000821:virology*; D006084:Graft Rejection; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000150:complications*; D008875:Middle Aged; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification*; D016035:Pancreas Transplantation / Q000009:adverse effects*
keywords: chronic diarrhea; colitis; diarrhea; end-stage renal disease; gastroenteritis; norovirus; organ rejection; pancreas transplant; solid organ transplantation