CMV-associated hemophagocytic syndrome accompanied by CMV hepatitis and pneumonia in renal transplant recipient: A case report
Eun Ji Choi1, Jun Bae Bang1.
1Department of Surgery, Ajou University Hospital, Suwon, Korea
Virus-associated hemophagocytic syndrome (HPS) is a rare but life threatening disease in renal transplant recipients that is mostly caused by cytomegalovirus and Epstein-Barr virus. However, to date, no description of CMV-associated hemophagocytic syndrome accompanied by CMV hepatitis and pneumonia exists in renal transplant recipients. Here, we report a 40-year-old male kidney recipient, who presented with epigastric discomfort, fever, and mild dyspnea two months following transplantation. Laboratory findings revealed bicytopenia, hyperferritinemia, elevated hepatic enzymes, elevated serum lactate dehydrogenase, low level of soluble IL2 receptor, and low NK cell activity. Lung HRCT showed bilateral lower lung ground glass opacity with peribronchiolar consolidation and interlobular septal thickening. Liver biopsy disclosed cytomegalovirus inclusions along with lymphocyte infiltration and erythrophagocytosis. The presence of CMV antigen and viral DNA in the recipient’s serum confirmed acute CMV infection. Following ganciclovir antiviral therapy without discontinuation of immunosuppressive therapy, symptoms gradually resolved and laboratory findings were normalized. As far as we know, this is the first case report CMV-associated hemophagocytic syndrome accompanied by CMV hepatitis and pneumonia in a renal transplant recipient.
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