Case Report of a Kidney Transplant Patient with Hemorrhagic Colitis

In post-transplant immunocompromised patients, cytomegalovirus (CMV) is a common viral infection. CMV can present in various ways, including colitis, gastritis, hepatitis, and leukopenia.

Mujtaba Hasnain, MD, FACP, and colleagues in the Department of Transplant Nephrology at Saint Barnabas Medical Center, Livingston, New Jersey, presented a case report of a patient with severe hemorrhagic colitis due to CMV infection during a poster session at the NKF 2015 Spring Clinical Meetings. The poster was titled Hemorrhagic Colitis Due to Cytomegalovirus Requiring Hemicolectomy in a Kidney Transplant Recipient.

The patient was a female, 71 years of age with a medical history of end-stage renal disease due to hypertension. She received a living donor kidney transplant, with a thymoglobulin induction at a dose of 6 mg/kg. Her maintenance immunosuppression included tacrolimus, prednisone, and mycophenolic acid. Because both donor and recipient were positive for serum CMV IgG antibodies, the patient received valganciclovir for 3 months for CMV prophylaxis.

At 4 months post-transplant, she presented with melena and fevers. Immediately following presentation, she developed hematochezia and went into hemorrhagic shock, requiring multiple transfusions. Bleeding scitinography showed active bleeding in the region of the distal small bowel. After coiled embolization did not control the bleeding, she underwent emergent right side hemicolectomy.

The patient’s serum CMV virus result was 3,900,000 copies/mL. She was treated with valganciclovir and mycophenolic acid was stopped. The pathology report of the resected segment of the colon showed severe ulceration of the entire colon with cells containing viral cytopathic effects, confirmed by immunohistochemistry, as CMV.

In their discussion of the implications of this case, the researchers noted that gastrointestinal CMV disease is becoming an increasingly recognized clinical problem in immunocompromised patients. Presentation of CMV can be very mild diarrhea, nausea, and vomiting, which is common, or very severe colitis, which is rare.

“Our patient developed hemorrhagic shock due to severe colitis and ultimately required hemicolectomy. If [a]kidney transplant recipient presents with a gastrointestinal bleed, CMV disease should be considered immediately. Timely diagnosis and treatment is extremely important as it can have fatal consequences,” the researchers added.

Source: Hasnain M, Hussain K, Saha B, Goldberg R. Hemorrhagic colitis due to cytomegalovirus requiring hemicolectomy in a kidney transplant recipient. Poster presented at the National Kidney Foundation Spring Clinical Meetings, March 2015, Dallas, Texas.