Kidney Week

Abstract: SA-PO1140

Cytomegalovirus-Associated Hemophagocytic Lymphohistiocytosis in a Deceased Donor Kidney Recipient: A Case Report

Session Information

• Transplantation: Clinical - Infectious Diseases
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Garcia Vallejo, Diana Vianney, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Diana Vianney Garcia Vallejo, MD

• Leal Lam, Sara Li, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Sara Li Leal Lam, MD

• Hernandez, Real Lorena, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Real Lorena Hernandez, PharmD, MEd, PhD

• Alcala, José Gilberto, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

José Gilberto Alcala, DrMed

• Banda Lopez, Adriana, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Adriana Banda Lopez, MD

• Cruz Landino, Moises, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Moises Cruz Landino, MD

Introduction

Cytomegalovirus (CMV)-associated hemophagocytic lymphohistiocytosis (HLH) is a rare and potentially fatal hyperinflammatory syndrome in kidney transplant recipients. Diagnosis is challenging because clinical manifestations overlap with severe infections and post-transplant complications. Early recognition and prompt treatment are critical to improve graft and patient survival.

Case Description

A 31-year-old kidney transplant recipient (CMV D+/R-) presented seven months post-transplant with fever, weight loss, hepatosplenomegaly, pancytopenia, hyperferritinemia, kidney allograft dysfunction, and CMV viremia >343,000 copies/mL, fulfilling criteria for secondary hemophagocytic lymphohistiocytosis (HLH) despite negative bone marrow findings. Treatment with dexamethasone, intravenous ganciclovir, IVIG, and immunosuppression reduction led to recovery of blood counts, liver function, and kidney allograft function. This case highlights the importance of early recognition of CMV-associated HLH after kidney transplantation.

Discussion

This case underscores that CMV-associated HLH may occur despite universal prophylaxis and in the absence of bone marrow hemophagocytosis. Because HLH frequently mimics sepsis in immunocompromised hosts, delayed recognition contributes substantially to mortality. Diagnosis should not be excluded by a negative bone marrow examination when clinical suspicion remains high. Early viral monitoring, prompt identification of CMV reactivation, and rapid initiation of targeted therapy may significantly improve patient and graft outcomes.

Clinical and biochemical evolution

*Timeline: Diagnosis was confirmed in September 2024, seven months after transplantation. ** Fibrinogen: Reported as Patient Value / Control Value.