SHM Converge Scientific Abstract ePoster Gallery-Renal Transplant Patient With Atypical Parasitic Infection Presentation

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A 71-year-old man with hypertension, diabetes, and a deceased-donor kidney transplant 2 years earlier presented with acute dark urine, nausea, vomiting, and intermittent diarrhea. He had been treated empirically with metoclopramide for presumed diabetic gastroparesis without improvement. He was afebrile and had an unremarkable exam, but labs showed low-level CMV viremia. EGD appeared grossly normal, while colonoscopy revealed erythematous polypoid lesions carpeting the colon from 30 cm onward.<br /><br />Biopsy confirmed CMV colitis by immunohistochemical staining. In addition, numerous Strongyloides stercoralis organisms were identified in the stomach, duodenum, and colon, indicating concurrent parasitic infection. The patient was treated with oral ivermectin 15 mg daily for 2 weeks for strongyloidiasis and IV ganciclovir 5 mg/kg every 12 hours, later transitioned to valganciclovir 900 mg twice daily, for a total CMV treatment course of 30 days. His gastrointestinal symptoms resolved after completion of therapy.<br /><br />This case highlights that renal transplant recipients are vulnerable to atypical and overlapping infections because of immunosuppression. Strongyloides infection is uncommon in the United States but can persist silently for years and reactivate under immunosuppression, especially with corticosteroid exposure, leading to hyperinfection or disseminated disease. The case emphasizes the importance of considering parasitic infection in transplant patients with persistent or unexplained gastrointestinal symptoms, even when more common diagnoses such as CMV are present.

Asset Subtitle

Varalakshmi Janamanchi

Meta Tag

Author List Elsoukkary S. Sarah, Eric Cober, Farah Abdulhai, Sara Haddad, Varalakshmi Janamanchi, Zain N. Jawad

Category Clinical Vignettes

Concept Kidney Transplantation

Concept Post-Transplant Infection

Concept Immunosuppression

Concept Strongyloides Infection

Concept Cytomegalovirus

Concept CMV Colitis

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic Foundation

Presenting Author Varalakshmi Janamanchi

Track Adult

Keywords

kidney transplant

CMV colitis

Strongyloides stercoralis

immunosuppression

gastrointestinal symptoms

valganciclovir

ganciclovir

ivermectin

renal transplant recipient

parasitic infection

Kidney Transplantation

Post-Transplant Infection

Immunosuppression

Strongyloides Infection

Cytomegalovirus

CMV Colitis