Cytomegalovirus (CMV) is the most important pathogen that affecting solid-organ transplant recipients. CMV infection can affect different organ system. There are frequent reports of CMV-induced adrenal insufficiency in HIV infection. Here we report a case of CMV-induced adrenal insufficiency in a renal transplant recipient. A 24-year-old women received living unrelated kidney transplantation. Immunosuppressive regimen was: cyclosporine, mycophenolate mofetil, and corticosteroid. Both donor and recipient had a positive anti-CMV IgG, and Negative IgM. Serum creatinine (Scr) level reached to 1.2 mg/dl at the 18-day after transplantation. On the 22-day Scr rose up to 3 mg/d and she received a course of anti-thymocyte glubuline therapy and serum creatinin level returned to 1, 5 mg/dl at the 28-day. At sixth week after transplantation again Scr raised up to 2.2mg/dl and serologic study revealed a positive anti-CMV IgM. Intravenous gancyclovir was started. At the beginning of fourth month of transplantation gradually she started complaining weakness and anorexia. Physical examination revealed a low blood pressure: 80/60 mm/Hg. At this time she was receiving 5 mg/day prednisolone. Laboratory investigation revealed: white blood cell count; 6900/µl, hemoglobin: 12 mg/dl, Scr; 1.5 mg/dl. Brown pigmentation of her face was visible. Prednisolone was changed to 15 mg/day oral hydrocortisone and continued for 2 weeks. Serum free cortisol was measure while she had taken hydrocortisone at the 8 am of the day before. Serum free cortisol was less than 5 µg/dl. We assessed the adrenal reserve capacity by injecting 1 mg tetracosactide and measuring the serum cortisol levels at 12 and 24 hours. In both instances it was below 18 µg/dl. With the diagnosis of primary adrenal insufficiency prednisolone level rose up to 10 mg/day and her symptoms improved. As far as we know this is the first proposed case of CMV induced adrenal insufficiency in renal transplant recipient. Although they receive corticosteroid, but in stressful condition the underlying adrenal insufficiency could be uncovered.
Volume : 6
Issue : 4
Pages : 56
Renal transplantation Unit, Imam Reza Hospital, Tabriz University of medical Sciences, Tabriz, Iran