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Kidney Week

Abstract: PO2448

A Case of Cytomegalovirus Infection with Splenic Infarction in a Renal Transplant Patient

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Co, Mita Zahra Estrada, Loma Linda University, Loma Linda, California, United States
  • Villicana, Rafael, Loma Linda University, Loma Linda, California, United States
  • Rattanavich, Rungwasee, Loma Linda University, Loma Linda, California, United States
Introduction

Cytomegalovirus (CMV) infection is common after kidney transplant (KT) but it is not known to be associated with splenic infarction.

Case Description

A 67-year-old female living-related KT recipient for end stage renal disease from systemic lupus erythematosus presented with acute fever, left flank pain, and diarrhea. Her medications included tacrolimus, mycophenolate mofetil (MMF), and prednisone. Examination was significant for fever (101.8°F) and abdominal tenderness. Labs revealed normal blood counts, metabolic profile (creatinine 0.9 mg/dL) and urinalysis. Stool study was negative for Clostridium difficile. Quantitative CMV DNA PCR was elevated at 126,000 IU/ml. Sigmoidoscopy with biopsy also showed CMV colitis. CT abdomen and pelvis with contrast (Fig 1A) showed multiple wedge-shaped hypodense foci in the spleen consistent with splenic infarction and a splenic artery that was widely patent. Further investigations including Doppler ultrasound of the lower extremities, lung VQ scan and hypercoagulable studies were all negative. CMV was suspected to be the cause of the splenic infarct. Thus, the patient was started on ganciclovir and anticoagulation and MMF was discontinued. On her 3-month follow-up, she was found to have improved symptoms, undetectable consecutive CMV titers and with interval radiographic resolution of her splenic infarctions (Fig 1B).

Discussion

By inciting an inflammatory response due to direct cytotoxic endothelial cell damage, CMV infection may cause a procoagulant state. This can lead to potentially life-threatening end-organ infarction such as splenic infarction. To our knowledge, this is the first reported case of CMV infection in a KT recipient presenting with splenic infarction. A high index of suspicion for this association is warranted for early recognition and treatment of these potentially reversible conditions.

Figure 1: CT image (A) showing splenic infarction with radiologic improvement (B) after CMV treatment.