Question 217

Question:

Three weeks after a renal transplant, a patient develops fever and leukopenia, followed by prostration and severe pulmonary and hepatic dysfunction. Which of the following is the most likely viral cause?

Correct Answer: C.  Cytomegalovirus

Cytomegalovirus (CMV) infection in immuncompetent hosts is usually subclinical, or at most presents as a mild form of mononucleosis similar to Epstein-Barr virus with mild fever, lymphadenopathy, splenomegaly and atypical circulating lymphocytes for several weeks. However, in immunocompromised hosts, such as the post-transplant patient above, CMV infection or reactivation of a latent CMV infection can manifest as a multisystem disease within 20-60 days. In addition to the aforementioned features of mononucleosis, CMV in immunocompromised hosts also manifests as pneumonia, hepatitis, gastritis and colitis. In late stage AIDS patients, CMV particularly causes a severe form of retinitis.
Adenovirus also causes a worsened form of its normal disease in immunocompromised hosts, but usually presents with severe gastroenteritis (vomiting and diarrhea) and pneumonia/bronchitis/ARD. Coxsackie virus usually presents in childhood as hand-foot-and-mouth disease, causing painful, vesicular, blisters in the oral mucosa, tonsillar pillars and palms and soles. Though influenza may cause a severely fatal pneumonia in immunocompromised hosts, it does not cause usually cause liver abnormalities. Parvovirus usually causes a chronic infection of the bone marrow and should be suspected in post-transplant patients with erythropoietin-resistant anemias.