Ureterostomy cytomegalovirus infection presenting as stoma ulceration in a kidney allograft receptor: A case report
Sección de Nefrología y Grupo de Trasplante Renal, Universidad de Antioquía, Hospital Universitario San Vicente de Paúl, Medillín, Colombia. Actas urologicas españolas
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Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.
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ABSTRACT: Cytomegalovirus (CMV) infection involving the skin is rare. We present a case of a renal transplant recipient who developed
fever and axillary, scrotal and penile skin ulcers after renal transplantation. The skin ulcers did not heal with antibiotics.
The skin biopsy revealed CMV inclusion bodies, CMV antigen on immunohistochemistry and high CMV DNA copies. The patient was
diagnosed with CMV cutaneous ulcers. The skin ulcers healed after treatment with intravenous ganciclovir and oral valganciclovir.
The diagnosis of CMV disease should be considered in the febrile immunosuppressed patient with skin ulcers. The biopsy of
the cutaneous lesions may provide the diagnostic clue in such patients.
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