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Kidney Week

Abstract: PO2098

Rare Oral Lesions from Cytomegalovirus in Kidney Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Tyagi, Alka A., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Doraiswamy, Mohankumar, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Singh, Priyamvada, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Murali, Raja Damayanthi, MetroHealth Medical Center, Cleveland, Ohio, United States
Introduction

Cytomegalovirus (CMV) infection occurs frequently with kidney transplant recipients and it can affect any segment of gastrointestinal tract, but intra-oral localization is exceedingly rare. We present an interesting rare oral lesion from CMV infection in kidney transplant recipient

Case Description

A 49-year-old male with a history of kidney transplant admitted with odynophagia, pancytopenia, neutropenic fever and new tongue lesion for two weeks. Examination showed a 3X3 cm elevated, adherent plaque. He has a history of resistant CMV viremia with failed therapy to low-dose valganciclovir, ganciclovir, and letomovir. He attained an undetectable CMV viral load with Foscarnet but it was complicated with acute renal injury, and he was transitioned to a high dose valganciclovir. His CMV PCR was < 50 on admission and biopsy of the tongue-lesion revealed a positive immunohistochemical stain for CMV. We held his Valcyte on admission and his pancytopenia improved with filgrastim. Repeat CMV PCR increased to 17,000 IU/mL. He refused Foscarnet and was restarted on oral valganciclovir (1350 mg twice daily) and topical cidofovir. Even with undetectable CMV at presentation, he was noted to have disseminated infection. Myfortic and Gengraf were held and discharged on prednisone alone. At 2-week follow-up,the lesion and its associated symptoms had resolved

Discussion

The presentation of oral CMV infection is highly variable with mucosal erythema, painful deep ulcers, erosions, but elevated tongue lesion have rarely been reported in literature to our knowledge. Treatment options includes ganciclovir, valganciclovir, foscarnet, letomovir and cidofovir. Early diagnosis is important because CMV increases other opportunistic infection and allograft rejection. Saliva and periodontal packets serve as reservoirs for CMV infection and frequent monitoring of periodontal health is needed post-transplant

3X3 cm elevated, adherent tongue lesions