Khosravi Masoud, Nobakht Ali, Nikokar Abdolah R
Division of Nephrology, Gilan University of Medical Sciences, Gilan, Iran.
Exp Clin Transplant. 2006 Jun;4(1):458-61.
Infection is a major problem after kidney transplantation. Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients. This report presents a rare clinical manifestation of CMV in the form of a hemorrhoid in a 58-year-old woman. One week after undergoing an external hemorrhoidectomy, the patient presented with fever, leukopenia, and thrombocytopenia. Pathological analysis showed CMV in the hemorrhoidal tissue, which was confirmed via a positive PP65 antigenemia assay. Therapy with ganciclovir (250 mg IV b.i.d. for 2 weeks) was started. The patient's response to treatment was good, and she has been doing well since that time. Her plasma creatinine level 2 years later was 79.2 micromol/L (normal range, 53-106 micromol/L). Physicians must always be aware of the hazards of CMV in immunocompromised patients with typical, and even with atypical, presentations. Taking into consideration the statement, "prophylaxis precedes treatment," nephrologists must try to detect CMV in their patients (especially during the first 6 months after transplantation) prior to the appearance of any clinical manifestations. If CMV is detected, pre-emptive therapy with ganciclovir should be started.
感染是肾移植后的一个主要问题。巨细胞病毒（CMV）是影响移植患者的最常见病毒感染。本报告呈现了一名58岁女性以痔疮形式出现的CMV罕见临床表现。在接受外痔切除术后一周，患者出现发热、白细胞减少和血小板减少。病理分析显示痔组织中有CMV，通过PP65抗原血症检测呈阳性得以证实。开始使用更昔洛韦治疗（静脉注射250mg，每日两次，共2周）。患者对治疗反应良好，自那时起情况一直良好。两年后她的血浆肌酐水平为79.2微摩尔/升（正常范围53 - 106微摩尔/升）。医生必须始终意识到CMV在免疫功能低下患者中以典型甚至非典型表现出现时的危害。考虑到“预防先于治疗”这一说法，肾病学家必须在患者出现任何临床表现之前，尝试在其患者中（尤其是在移植后的前6个月）检测CMV。如果检测到CMV，应开始使用更昔洛韦进行抢先治疗。
