Department of Internal Medicine, Jeonbuk National University Hospital, 20 Geonji-Ro, Deokjin-Gu, 54907, Jeonju-Si, Republic of Korea.
Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Jeonjuk, Korea.
BMC Nephrol. 2023 Mar 24;24(1):69. doi: 10.1186/s12882-023-03127-z.
The coinfection between cytomegalovirus (CMV) and either human herpesvirus-6 (HHV-6) or HHV-7 in renal transplant recipients is well known; however, there have been few reports of coinfection of CMV associated with HHV-8. This paper presents a first case of acute gastric ulcer and duodenitis associated with CMV and HHV-8 coinfection after renal transplantation.
A 33-year-old male with a history of kidney transplantation was admitted to hospital because of postural epigastric pain. The recipient was CMV seropositive prior to transplantation and received trimethoprim-sulfamethoxazole without universal prophylaxis. Approximately 5 months after renal transplant, the recipient complained postural epigastric pain. An endoscopy revealed diffuse ulcerative lesions in the lower body and in the antrum of the stomach, as well as several erythematous mucosal lesions in the duodenum. Histopathologic examination identified CMV inclusions consistent with invasive CMV disease and immunohistochemical staining showed positive results for HHV-8 and CMV. No tumorous diseases such as Kaposi's sarcoma were detected. After 3 weeks of intravenous ganciclovir treatment, we observed that serum CMV PCR remained within the normal range and clinical symptoms improved. A follow-up endoscopy performed 3 weeks later showed that the severity of the above mentioned lesions had improved.
We report the first case of a renal transplant recipient diagnosed with acute gastric ulcer and duodenitis associated with coinfection of CMV and HHV-8. Ganciclovir appears to be effective in diseases associated with coinfection of CMV and HHV-8.
巨细胞病毒（CMV）与人类疱疹病毒-6（HHV-6）或 HHV-7 的合并感染在肾移植受者中已广为人知；然而，CMV 与 HHV-8 合并感染的报道较少。本文报告首例肾移植后 CMV 与 HHV-8 合并感染引起的急性胃溃疡和十二指肠炎。
一名 33 岁男性，有肾移植病史，因体位性上腹痛入院。受者在移植前 CMV 血清阳性，未接受普遍预防而接受复方磺胺甲噁唑。肾移植后约 5 个月，受者出现体位性上腹痛。内镜检查显示胃体和胃窦部弥漫性溃疡性病变，以及十二指肠多处红斑性黏膜病变。组织病理学检查发现符合侵袭性 CMV 病的 CMV 包涵体，免疫组化染色显示 HHV-8 和 CMV 阳性。未发现卡波西肉瘤等肿瘤性疾病。静脉用更昔洛韦治疗 3 周后，我们观察到血清 CMV PCR 仍在正常范围内，临床症状改善。3 周后随访内镜检查显示上述病变严重程度改善。
我们报告首例肾移植受者诊断为急性胃溃疡和十二指肠炎，与 CMV 和 HHV-8 合并感染有关。更昔洛韦似乎对 CMV 和 HHV-8 合并感染相关疾病有效。
