Acute infection of Toxoplasma gondii and cytomegalovirus reactivation in a pediatric patient receiving liver transplant

ML Galván Ramírez, Y Castillo‐de‐León… - Transplant Infectious …, 2006 - Wiley Online Library
ML Galván Ramírez, Y Castillo‐de‐León, M Espinoza‐Oliva, MC Bojorques‐Ramos…
Transplant Infectious Disease, 2006Wiley Online Library
A 7‐year‐old Mexican boy with end‐stage cirrhosis underwent liver transplantation and was
maintained with cyclosporine and prednisolone. No specific data about Toxoplasma gondii
or cytomegalovirus (CMV) infections in the cadaver donor were available. The recipient was
seronegative for Toxoplasma, but CMV‐IgG positive before transplantation. Ganciclovir was
administered for prophylaxis during 3 months, but 5 months later he presented with icterus
and increased transaminases. Acute transplant rejection was ruled out by biopsy. A …
Abstract
A 7‐year‐old Mexican boy with end‐stage cirrhosis underwent liver transplantation and was maintained with cyclosporine and prednisolone. No specific data about Toxoplasma gondii or cytomegalovirus (CMV) infections in the cadaver donor were available. The recipient was seronegative for Toxoplasma, but CMV‐IgG positive before transplantation. Ganciclovir was administered for prophylaxis during 3 months, but 5 months later he presented with icterus and increased transaminases. Acute transplant rejection was ruled out by biopsy. A seroconversion for T. gondii IgM and IgG and a small increase in CMV‐IgM antibodies were observed, although the CMV‐polymerase chain reaction (PCR) was negative. Ganciclovir was re‐started, and the patient improved, but 6 months later he relapsed, and chorioretinitis lesions compatible both with T. gondii and CMV infections appeared. Pyrimethamine, sulfadiazine, folinic acid, and ganciclovir were administered. The boy showed favorable clinical improvement and remained stable for 12 months. Then, new retinal CMV lesions appeared in both eyes and the PCR for CMV became positive; therefore, the patient received a new regimen of ganciclovir, and clinically improved. From these data we concluded that the child presented a reactivation of CMV and a primary infection with T. gondii after transplantion.
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