Correspondence Address:
Mohammed Abdelrahman
Department of Nephrology, Kanoo Kidney Centre, Dammam Medical Complex, P.O. Box 10387, Dammam 31433
Saudi Arabia

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To the Editor,

Cytomegalovirus virus (CMV) infection and disease is the major infectious complication in renal allograft recipients, and is known as an independent risk factor for acute rejection and chronic allograft dysfunction. We describe primary CMV infection in a 55 year old male patient with end stage renal disease due to Diabetic nephropathy. The patient, who was CMV negative, received live unrelated renal transplant abroad from a positive CMV donor with full recovery of renal function. He was placed on cyclosporine, prednisolone, and mycophenolate mofetil, together with acyclo­vir and sulphamethoxazole/Trimethoprim. Six weeks after transplantation, he presented with fever, malaise, anorexia and cellulites of the right toe. Laboratory investigations showed leukopenia, minimally impaired liver function tests, and E. coli and pseudomonas aeruginosa were cultured from the right toe. Antibiotics were prescribed but his fever persisted. Con­sequently, he developed dysphagia, and re­testing for CMV IgM was positive (PCR was not available). Gastroscopy showed active chronic gastritis with esophageal inflammation and ulceration. Esophageal biopsy revealed features suggestive of herpes simplex and/or CMV infection [Figure 1] and [Figure 2]. The patient was started and maintained on gancyclovir intravenously for 3 weeks. Thereafter, he be­came afebrile, the dysphagia resolved, liver function tests became normal and CMV IgG became positive. We conclude that prophylactic treatment with gancyclovir is essential in renal transplant recipients especially in the D+/R­setting.