P5596 - Extensive CMV Infection of the Upper and Lower Gastrointestinal Tract in Kidney Transplant Patient

Merina Varghese, BA¹, Sami Ghazaleh, MD², Benjamin R. Hart, MD, PhD, MPH³
1University of Toledo College of Medicine and Life Sciences, Toledo, OH; 2University of Toledo, Toledo, OH; 3University of Toledo College of Medicine, Toledo, OH

Introduction: Cytomegalovirus (CMV) is one of the most common pathogens that affects severely immunocompromised individuals, especially transplant patients. Here, we report a rare case of CMV infection involving the entire alimentary tract of a kidney transplant patient.

Case Description/

Methods: A 63-year-old female with end stage renal disease secondary to IgA nephropathy status post renal transplant on chronic immunosuppression was admitted to the hospital due to diarrhea and increasingly diffuse abdominal pain. Along with initial stabilization, lab work obtained was overall unremarkable. CT imaging was notable for sigmoid diverticulosis. Given her immunosuppression, infectious work-up was initiated. Both BK virus and plasma CMV were elevated, suggesting CMV infection. Esophagogastroduodenoscopy (EGD) and colonoscopy showed multiple erosive ulcerations in the esophagus, stomach, and duodenum, multiple erosions and aphthous ulcerations within the terminal ileum, and scattered erosions and ulcerations in the cecum, ascending colon, and proximal transverse colon. Multiple biopsies were obtained and upon histopathological evaluation were consistent with severe CMV esophagitis, gastritis, duodenitis, enteritis, and colitis. Given her renal transplant serostatus of CMV Donor Positive, Recipient Negative, she was started on empiric intravenous ganciclovir until diarrhea symptoms resolved and transitioned to oral valganciclovir. She was discharged with valganciclovir with infectious disease and gastroenterology follow up. In the following months, plasma CMV levels continued to decline; however, the patient still endorsed diarrhea and abdominal fullness. Re-evaluation for CMV status, viral load, and further work up for diarrhea consisted of EGD, which showed resolution of ulcerative lesions and reduced viral load. Patient’s progress continues to be closely monitored.

Discussion: CMV is a herpesvirus that is controlled by a vigorous immune response in most immunocompetent individuals, resulting in a mild disease course. However, in immunocompromised hosts, CMV infection can lead to several health complications including end-organ disease. While CMV infection can affect the alimentary tract, the most common location for CMV infection remains the colon. To our knowledge, this is one of the only documented cases of a patient with simultaneous CMV infection of multiple sites throughout their entire alimentary tract. Treatment includes ganciclovir and valganciclovir and requires continuous monitoring of viral load.

Disclosures:
Merina Varghese indicated no relevant financial relationships.
Sami Ghazaleh indicated no relevant financial relationships.
Benjamin Hart indicated no relevant financial relationships.

Merina Varghese, BA¹, Sami Ghazaleh, MD², Benjamin R. Hart, MD, PhD, MPH³. P5596 - Extensive CMV Infection of the Upper and Lower Gastrointestinal Tract in Kidney Transplant Patient, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.