Browse > Article
http://dx.doi.org/10.3339/jkspn.2010.15.1.76

Late Cytomegalovirus Disease Causes Ileal Perforation after Kidney trasplantation  

Lee, Hee-Woo (Department of Pediatrics, Eulji University School of Medicine)
Hahn, Hye-Won (Department of Pediatrics, Eulji University School of Medicine)
Park, Young-Seo (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
Publication Information
Childhood Kidney Diseases / v.15, no.1, 2011 , pp. 76-80 More about this Journal
Abstract
Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.
Keywords
Cytomegalovirus; Kidney transplantation; Ileal perforation;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Jassal SV, Roscoe JM, Zaltzman JS, Mazzulli T, Krajden M, Gadawski M. Clinical practice guidelines: prevention of cytomegalovirus disease after renal transplantation. J Am Soc Nephrol 1998;9:1697-708.
2 Zylber-Katz E, Granot E. Abrupt increase of Tacrolimus blood levels during an episode of Shigella infection in a child after liver transplantation. Ther Drug Monit 2001;23: 647-9.   DOI   ScienceOn
3 Hochleitner BW, Bosmuller C, Nehoda H, Fruhwirt M, Simma B, Ellemunter H, et al. Increased tacrolimus levels during diarrhea. Transpl Int 2001;14:230-3.   DOI   ScienceOn
4 Slifkin M, Tempesti P, Poutsiaka DD, Snydman DR. Late and atypical cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis 2001;33:E62-8.   DOI
5 Snydman DR, Werner BG, Heinze-Lacey B, Veradi VP, Tilner NL. Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal transplant recipients. N Engl J Med 1987;317:1049-54.   DOI   ScienceOn
6 Tanaka Y, Kanda Y, Kami M, Mori S, Amaki T, Kusumi E, et al. Monitoring cytomegalovirus infection by antigenemia assay and two distinct plasma real-time PCR methods after hematopoietic stem cell transplantation. Bone Marrow Transplant 2002;30:315-9.   DOI   ScienceOn
7 Griscelli F, Barrois M, Chauvin S, Lastere S, Bellet D, Bourhis JH. Quantitation of human cytomegalovirus DNA in bone marrow transplant recipient by real-time PCR. J Clin Microbiol 2001;39:4362-9.   DOI   ScienceOn
8 Fisher L, Rautenberg P, Bienengrabe H, Leimenstoll G. Antigenemia, immunoblotting, and enzyme immunoassay for early diagnosis of cytomegalovirus infection in renal transplant patients. Transpl Int 1993;6:201-5.   DOI   ScienceOn
9 Komorowski RA, Cohen EB, Kauffman HM, Adams MB. Gastrointestinal complications in renal transplant recipients. Am J Clin Pathol 1986;86:161-7.   DOI
10 Mathew TH. A blinded, long-term, randomized multicenter study of mycophenolate mofetil in cadavaric renal transplantation: results at three years. Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. Transplantation 1998;65:1450-4.   DOI   ScienceOn
11 Sarmiento JM, Dockrell DH, Schwab TR, Munn SR, Paya CV. Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients. Clin Transplant 2000;14:136-8.   DOI   ScienceOn
12 ter Meulen CG, Wetzels JFM, Hilbrands LB. The influence of mycophenolate mofetil on the incidence and severity of primary cytomegalovirus infections and disease after renal transplantation. Nephrol Dial Transplant 2000;15:711-4.   DOI
13 Abbott KC, Hypolite IO, Viola R, Poropatich RK, Hshieh P, Cruess D, et al. Hospitalization for cytomegalovirus disease after renal transplantation in the United States. Ann Epidemiol 2002;12:402-9.   DOI   ScienceOn
14 Pouteil-Noble C, Ecochard R, Landrivon G, Donia-Maged A, Tardy JC, Bosshard S, et al. Cytomegalovirus infection-an etiological factor for rejection? A prospective study in 242 renal transplant patients. Transplantation 1993;55:851-7.   DOI   ScienceOn
15 Bock GH, Sullivan EK, Miller D, Gimon D, Alexander S, Eloois E, et al. Cytomegalovirus infections following renal transplantation-effects of antiviral prophylaxis: A report of the North American Pediatric Renal Transplant Cooperative Study. Pediatric Nephrol 1997;11:665-71.   DOI   ScienceOn
16 Robinson LG, Hilinski J, Graham F, Hymes L, Beck-Sague CM, Hsia J, et al. Predictors of cytomegalovirus disease among pediatric transplant recipients within one year of renal transplantation. Pediatr Transplant 2002;6: 111-8.   DOI   ScienceOn
17 Wolf DG, Spector SA. Early diagnosis of human cytomegalovirus disease in transplant recipient by DNA amplification in plasma. Transplantation 1993;56:330-4.   DOI   ScienceOn