Abstract Details

Title Disseminated Cytomegalovirus Infection with Meningoencephalitis in an Immunosuppressed Renal Transplant Patient

Topic Infectious Disease

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-001

Background Cytomegalovirus (CMV) can present clinically in a broad spectrum of manifestations, ranging from a brief illness defined as mononucleosis-like syndrome to more devastating multi-system disease. Increased morbidity and mortality are especially documented in immunocompromised adults. Recipients of organ transplants are maintained on long-term immunosuppressive agents, hence they are at high risk of systemic CMV infection. We describe a case of a post renal transplant patient on immunosuppression with disseminated CMV disease.

Objective NA

Design/Methods NA

Results A 62-year-old man with history notable for renal transplant on chronic immunosuppression was admitted for increased lethargy and confusion along with decreased oral intake and abdominal pain. His hospital course was complicated by persistent encephalopathy, fever, and worsening respiratory status. He ultimately underwent multiple imaging studies and laboratory testing, including CT abdomen concerning for enterocolitis and CT chest concerning for pneumonia. Lumbar puncture revealed presence of CMV in cerebrospinal fluid on polymerase chain reaction testing. EEG showed presence of frequent multifocal sharp waves. He was started on valproic acid for suspicion of subclinical seizures. Interestingly, routine testing had showed no CMV viral load few months prior to admission. He was diagnosed with CMV meningoencephalitis, with clinical suspicion for more widespread disease including CMV colitis and CMV pneumonia. He was started on IV ganciclovir and had significant reduction in CMV viral load. Ultimately, he experienced improvement of his cognitive status and was discharged home with home health.

Conclusions Disseminated CMV disease is a concern for immunocompromised patients, and diagnosis should be considered even if recent monitoring studies have been negative. The initial manifestation can be cognitive impairment and lethargy, and typical signs of infection such as fever may not be seen. Clinicians must have a high degree of suspicion for opportunistic infection in immunocompromised patients, especially if a unifying diagnosis remains elusive.

Authors/Disclosures
Jaspreet Johal, MD PRESENTER	Dr. Johal has nothing to disclose.
Ramiro G. Castro Apolo, MD (Lehigh Valley Health Network)	Dr. Castro Apolo has nothing to disclose.
Negar Moheb, MD (Mayo Clinic)	Dr. Moheb has nothing to disclose.
Hussam A. Yacoub, DO (The Lehigh Valley Health Network)	Dr. Yacoub has nothing to disclose.