Gorsane Imen, Aloui Sabra, Letaif Ahmed, Hadhri Rim, Haouala Faouzi, Frih Ameur, Dhia Naceur Ben, Elmay Mezri, Skhiri Habib
Department of Nephrology, Hospital Fattouma Bourguiba, Monastir, Tunisia.
Saudi J Kidney Dis Transpl. 2013 Mar;24(2):309-14. doi: 10.4103/1319-2442.109588.
We report a rare case of cytomegalovirus (CMV)-associated ischemic colitis and transverse myelitis (TM) occurring precociously after renal transplantation. A 57-year-old male was transplanted with a cadaveric kidney on 5 June 2009. The patient was CMV seropositive and the donor was seronegative. Transplantation was followed shortly by TM, which resulted in paraplegia. The results of magnetic resonance imaging of the spinal cord showed abnormalities. Twenty days after transplantation, he developed abdominal pain with melena and was diagnosed as having CMV-associated ischemic colitis confirmed by colonoscopy and biopsy. Serological data and identification of the viral genome by polymerase chain reaction were confirmatory for CMV. Treatment consisted of intravenous ganciclovir, followed by polyvalent immunoglobulin. The outcome was favorable. Symptomatic CMV infection is relatively common among the renal transplant population. Early colonoscopy is beneficial for making a quick diagnosis and therefore helps to institute a prompt management of CMV colitis. Myelitis is less common in transplant recipients and diagnosis, therefore, was more difficult.
我们报告了一例肾移植后过早发生的巨细胞病毒（CMV）相关性缺血性结肠炎和横贯性脊髓炎（TM）的罕见病例。一名57岁男性于2009年6月5日接受了尸体肾移植。患者CMV血清学阳性，供体血清学阴性。移植后不久发生了TM，导致截瘫。脊髓磁共振成像结果显示异常。移植后20天，他出现腹痛并伴有黑便，经结肠镜检查和活检确诊为CMV相关性缺血性结肠炎。血清学数据以及通过聚合酶链反应对病毒基因组的鉴定证实为CMV感染。治疗包括静脉注射更昔洛韦，随后使用多价免疫球蛋白。结果良好。有症状的CMV感染在肾移植人群中相对常见。早期结肠镜检查有助于快速诊断，从而有助于及时对CMV结肠炎进行管理。脊髓炎在移植受者中较少见，因此诊断更困难。
