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Bloody Diarrhea with Pseudo-Obstruction of Intestine in a Renal Transplant Recipient
並列摘要
Diarrhea is frequent in renal transplant (RTx) recipients. Differentiating among the various infectious diseases and medications which may have caused diarrhea in transplant recipients is an important challenge. Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in RTx recipients. The gastrointestinal tract, especially the colon and rectum, is the organ most frequently invaded by CMV disease. CMV colitis presents with or without fever, gastrointestinal bleeding, pseudoobstruction, ischemic colitis and perforation. Here we report a case of profound diarrhea with acute renal failure, which progressed to neutropenic fever, thrombocytopenia, bloody diarrhea and pseudoobstructive intestine. Colonoscopic biopsy revealed CMV colitis. The symptoms deteriorated rapidly despite ganciclovir therapy, and surgical intervention was required. The patient survived the life-threatening disease after surgery and received 3-month ganciclovir therapy without complication. High clinical suspicion of CMV disease and early colonoscopy are necessary for prompt recognition and effective medical therapy in RTx recipients presenting with diarrhea. (Acta Nephrologica 2011; 25: 132-136)
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