SYNDROMIC DIAGNOSIS IN A CHILD WITH POST RENAL TRANSPLANT

Abstract

9 Years old boy who underwent renal transplant, on immunosuppression for past 2 years presented with chronic abdomen pain. Oesophageal biopsy done outside showed features of post-transplant lymphoproliferative disorder (PTLD). He presented with fast breathing and was found to have acute renal dysfunction and severe anaemia requiring transfusion along with leukopenia. Chest X ray showed bilateral lower lobe consolidation. Acute on chronic graft dysfunction was suspected and he was evaluated for PTLD and infections as a cause. Epstein-Barr Virus (EBV) and BK virus was negative. Repeat oesophageal biopsy showed ulceration with cytomegaloviral inclusions. The diagnosis of Cytomegaloviral (CMV) syndrome was made as CMV viral counts were signicantly elevated. He was treated with parenteral ganciclovir and other supportive treatment following which his renal parameters showed dramatic improvement. Infectious causes should always be considered in post renal transplant. CMV infection is common between 30 and 90 days after transplantation. But this child presented after 2 years with involvement of lungs, kidney, oesophagus and bicytopenia thus pointing towards CMV syndrome with end organ damage