Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient.

Abstract

Cytomegalovirus (CMV) is an important pathogen in organ-transplant recipients. There have been frequent reports of CMV-induced adrenal insufficiency in patients with human immunodeficiency virus infection. Herein, we report CMV-induced renal insufficiency in a renal transplant recipient. A 24-year-old woman had gradual onset of weakness, anorexia, nausea, hypotension, and skin hyperpigmentation at 5 months after renal transplantation. The immunosuppression regimen included cyclosporine, mycophenolate mofetil, and corticosteroid (prednisolone, 5 mg/d). Recent history included acute CMV infection, which was treated with ganciclovir. Basal serum cortisol concentration was 4 microg/dL, and stimulated serum cortisol concentration was less than 10 microg/dL. All clinical signs and symptoms and hypotension gradually improved after the oral prednisolone dose was increased to 10 mg/d. Clinicians must be aware of the possibility of CMV-induced adrenal insufficiency in renal transplant recipients. The condition may be symptomatic despite low-dose prednisolone therapy.

• Authors: M Ardalan, M M Shoja
• Journal: Transplantation proceedings (Transplant Proc) Vol. 41 Issue 7 Pg. 2915-6 (Sep 2009) ISSN: 1873-2623 [Electronic] United States
• PMID: 19765472 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Viral
• Antilymphocyte Serum
• Immunoglobulin G
• Immunoglobulin M
• Immunosuppressive Agents
• Prednisolone
• Creatinine
• Hydrocortisone

Topics

• Adrenal Insufficiency (virology)
• Antibodies, Viral (blood)
• Antilymphocyte Serum (therapeutic use)
• Creatinine (blood)
• Cytomegalovirus (immunology)
• Cytomegalovirus Infections (complications, diagnosis)
• Female
• Humans
• Hydrocortisone (blood, therapeutic use)
• Immunoglobulin G (blood)
• Immunoglobulin M (blood)
• Immunosuppressive Agents (therapeutic use)
• Kidney Transplantation (adverse effects)
• Postoperative Complications (virology)
• Prednisolone (therapeutic use)
• Treatment Outcome
• Young Adult