Cytomegalovirus Disease in Kidney Transplantation: The Contribution of Histology to Diagnosis — A Case Report and Regional Literature Review

Background

Cytomegalovirus (CMV) infection is the most common opportunistic viral infection in kidney transplant recipients, with prevalence 18–56% depending on donor/recipient serology. Highest risk is in CMV- seronegative recipients of CMV-seropositive organs (D+/R−), where primary infection can be severe. Histology is critical for diagnosing tissue-invasive CMV disease, especially in atypical presentations with equivocal virological assays. Case Presentation: A 32-year-old male kidney transplant recipient developed CMV disease 18 months post-transplantation from his HLA semi-identical sister. He presented with altered general condition, severe epigastric pain, acute diarrhea, and vomiting. Laboratory findings: leukopenia, thrombocytopenia, and hepatic cytolysis (2× normal) without graft dysfunction. Abdominal CT showed mesenteric lymphadenopathy and splenomegaly. CMV antigenemia (pp65) was positive. Gastroscopy revealed severe congestive pangastritis; gastric biopsies confirmed CMV DNA by histopathology. He was treated with ganciclovir 300 mg/day for 21 days, with favorable evolution.