Acalculous Cholecystitis: An Unusual Manifestation of Cytomegalovirus Disease in Renal Transplant Recipient

Mostapha Habib Allah,Inass Laouad,Nour Houda Bassit,Wafaa Fadili

doi:10.4236/ojneph.2013.32020

Abstract

Background: Common clinical manifestations of cytomegalovirus (CMV) infection include flu-like symptoms with fever, diarrhea, leukopenia, and elevated liver enzymes. Diagnosis is made by detection of the virus by buffy-coat blood culture or by polymerase chain reaction (PCR) analysis. Methods: Here we describe a women renal transplant recipient who presented with acalculous cholecystitis with CMV viremia, anemia and leucopenia tree months after she received a kidney from cadaveric donor. Results: Retrospective analysis of peripheral blood by PCR analysis was positive for CMV DNA. Treatement with Intravenous Ganciclovir was started after diagnosis. The role of cholecystectomy in patients diagnosed as having acalculous cholecystitis associated with systemic CMV disease remains unclear. Conclusions: Because CMV infection is common in transplant patients, the atypical manifestations of CMV should be considered in the differential diagnosis of posttransplant complications. Detection of CMV DNA in the peripheral blood by PCR analysis may help identify these patients.

Highlights

Cytomegalovirus infection is common in renal transplant recipients in the first 3 - 6 months after transplant [1]
Here we describe a women renal transplant recipient who presented with acalculous cholecystitis with CMV viremia, anemia and leucopenia tree months after she received a kidney from cadaveric donor
Because CMV infection is common in transplant patients, the atypical manifestations of CMV should be considered in the differential diagnosis of posttransplant complications

Summary

Introduction

Cytomegalovirus infection is common in renal transplant recipients in the first 3 - 6 months after transplant [1]. We report a case of renal transplant recipients who experienced unusual manifestations of tissue-invasive CMV disease (cholecystitis). After 4 months of transplantation with severe right upper quadrant abdominal pain, fever and vomiting. Her immunosuppression consisted of Thymoglobuline, mycofenolate mofetil, prednisolone and cyclosprine. Abdominal ultrasound revealed sludge and a thinwalled gallbladder Prior to her transplant, she was CMV seropositive. She didn’t receive a prophylaxis against CMV. At that stage her CMV PCR was 1,341,000 copies/mL. At the last follow-up 2 months later, the patient had stable graft function with no recurrence of CMV disease

Discussion

Summary