Department of Renal Medicine, Singapore General Hospital, Singapore.
SingHealth-Duke NUS Transplant Centre, SingHealth, Singapore.
Transpl Infect Dis. 2021 Aug;23(4):e13694. doi: 10.1111/tid.13694. Epub 2021 Jul 23.
Pseudomembranous colitis (PMC) is classically associated with Clostridium difficile infection. We report a rare case of cytomegalovirus (CMV)-associated PMC in a 52-year-old female patient who had undergone kidney transplantation more than 20 years ago and was on low dose prednisolone and ciclosporin. She presented with an acute history of fever, lethargy, vomiting and diarrhoea on admission. Computed tomography of the abdomen showed extensive colitis, and colonoscopy revealed extensive pseudomembrane formation. Multiple tests for Clostridium difficile and other common microbiological causes of colitis were negative. CMV DNAemia and colonic biopsies confirmed the diagnosis of CMV colitis. The patient responded to prompt CMV treatment, as demonstrated by clinical, endoscopic, and histological response. While CMV is a common pathogen in the solid organ transplant population that is familiar to most transplant physicians, it may present atypically as PMC. Here, we review the literature on CMV-associated PMC and its relevance to solid organ transplant recipients. To our knowledge, this is the first reported case of CMV-associated PMC in a kidney transplant recipient.
伪膜性结肠炎（PMC）通常与艰难梭菌感染相关。我们报告了一例罕见的巨细胞病毒（CMV）相关性 PMC 病例，患者为 52 岁女性，20 多年前接受过肾移植，目前接受低剂量泼尼松龙和环孢素治疗。患者入院时表现为急性发热、嗜睡、呕吐和腹泻。腹部 CT 显示广泛结肠炎，结肠镜检查显示广泛的假膜形成。艰难梭菌和其他常见结肠炎微生物病因的多项检测均为阴性。CMV 血症和结肠活检证实了 CMV 结肠炎的诊断。患者对 CMV 治疗有快速反应，临床、内镜和组织学均有反应。虽然 CMV 是大多数移植医生熟悉的实体器官移植人群中的常见病原体，但它可能以 PMC 的非典型形式出现。在此，我们复习了关于 CMV 相关性 PMC 的文献及其与实体器官移植受者的相关性。据我们所知，这是首例肾移植受者 CMV 相关性 PMC 的报道。
