Dahman Mohamed, Krell Robert, Brayman Kenneth, Sawyer Robert G, Cathro Helen P, Hagspiel Klaus D, Sifri Costi D, Bonatti Hugo J R
Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, VA 22908, U.S.A.
Ann Transplant. 2010 Oct-Dec;15(4):72-6.
Infection remains the most common complication following renal transplantation (RT). Cytomegalovirus (CMV) is one of the most important pathogens in this patient population and Clostridium difficile-associated colitis (CDAC) has emerged as one of the most frequent gastrointestinal complications. Only few cases of simultaneous CMV enterocolitis and CDAC have been reported.
A 73-year-old woman who underwent RT more than 10 years earlier developed severe abdominal pain and profound bloody diarrhea. She was diagnosed with simultaneous CMV enterocolitis and CDAC and treated with ganciclovir and metronidazole. She was unable to clear the infections and underwent colonic and small bowel resection, but ultimately died from indirect complications following the two severe infections.
Late-onset CMV disease in this patient who was CMV negative prior to transplantation and received a CMV-negative graft was an unexpected event; the simultaneous occurrence of CDAC aggravated the clinical picture ultimately leading to surgery, graft failure and death. Clinicians should be aware that opportunistic infections may develop many years post transplant and may occur simultaneously.
感染仍然是肾移植（RT）后最常见的并发症。巨细胞病毒（CMV）是该患者群体中最重要的病原体之一，艰难梭菌相关性结肠炎（CDAC）已成为最常见的胃肠道并发症之一。仅有少数同时发生CMV小肠结肠炎和CDAC的病例报道。
一名10多年前接受肾移植的73岁女性出现严重腹痛和大量血便。她被诊断为同时患有CMV小肠结肠炎和CDAC，并接受了更昔洛韦和甲硝唑治疗。她未能清除感染，接受了结肠和小肠切除术，但最终死于这两种严重感染后的间接并发症。
该患者移植前CMV阴性且接受了CMV阴性移植物，发生迟发性CMV疾病是一个意外事件；CDAC的同时发生加重了临床症状，最终导致手术、移植物失功和死亡。临床医生应意识到机会性感染可能在移植多年后发生，且可能同时出现。
