Abstract: PUB295
CMV-Associated Thrombosis in a Kidney Transplant Recipient
Session Information
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Hsu, Young C., University of Southern California, Los Angeles, California, United States
- Wang, Lin, University of Southern California, Los Angeles, California, United States
- Cao, Thanh, University of Southern California, Los Angeles, California, United States
- Sharma, Neeraj, University of Southern California, Los Angeles, California, United States
Introduction
Cytomegalovirus (CMV) infection is a common infectious complication after kidney transplantation. Indirect effects of CMV infection include an increased risk of secondary infections, increased risk of acute rejection and chronic allograft dysfunction. However, it is not well known that CMV may also increase the risk of venous and arterial thrombosis. Here we present a case of acute deep venous thromboembolism associated with acute CMV disease in a kidney transplant recipient.
Case Description
A 64 year old male presented with 4 weeks of sore throat, cough, subjective fevers, and fatigue. 3 weeks prior, he presented to an outside hospital with flu-like symptoms and complaints of right calf pain. Imaging showed the right leg with totally thrombosed posterior tibial and peroneal veins as well as acute partially thrombosed popliteal vein. The patient was subsequently admitted to the hospital and found with a CMV PCR of 35,900 IU/ml, after which he underwent an esophagogastroduodenoscopy (EGD) and colonoscopy with biopsies confirming CMV in the lower esophagus consistent with CMV esophagitis. IV ganciclovir treatment was initiated with appropriate response seen.
Discussion
CMV belongs to the herpesvirus family that establishes latent infection following a primary infection. For patients who are CMV seropositive, the risk of CMV reactivation is highest in the setting of systemic immunosuppression. CMV infections may present with a wide array of syndromes ranging from meningoencephalitis to enteritis/colitis and hepatitis. In addition, CMV infection has been associated with thromboembolic events. Kidney transplant recipients show a high prevalence of thrombotic events compared with the general population. In short, acute CMV infection should be considered as a risk factor for venous thromboembolism. Therefore, diagnosis of acute CMV infection in patients with an acute thrombosis should redefine the thrombotic event as provoked rather than unprovoked, limiting the duration of anticoagulation treatment.