Journal Article

Late and Atypical Cytomegalovirus Disease in Solid-Organ Transplant Recipients

Michelle Slifkin, Paola Tempesti, Debra D. Poutsiaka and David R. Snydman

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 33, issue 7, pages e62-e68
Published in print October 2001 | ISSN: 1058-4838
Published online October 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/322663
Late and Atypical Cytomegalovirus Disease in Solid-Organ Transplant Recipients

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Posttransplantation cytomegalovirus (CMV) disease typically occurs 1–4 months after solid-organ transplantation. The case definition invariably includes unexplained fever for ⩾3 days, often with leukopenia. Late and atypical presentation of CMV disease has been rarely reported. Five cases of late and atypical CMV disease in heart (n = 1), liver (n = 1), and kidney (n = 3) transplant recipients occurred within a 4-month period in early 1999. These patients presented at a median of 25 months after organ transplantation (range, 6 months to 22 years). Atypical findings included absence of fever in 3 patients, elevated white blood cell counts in 4 patients, and normal platelet counts in 4 patients. Four patients were at risk for primary CMV infection, and 3 received ganciclovir prophylaxis for 3 months. One patients was treated for rejection, and 2 patients had induction muromonab-CD3 (Orthclone; Orthobiotech). Two of the patients had pulmonary CMV disease, but neither of these patients had hypoxia. Two patients had enterocolitis, one of whom had chronic colitis for a year. These cases may represent a changing epidemiology and clinical presentation of CMV disease in solid-organ transplant recipients in an era of changing immunosuppression and improved CMV disease prevention in the early posttransplantation period.

Journal Article.  3924 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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