SHM Converge Scientific Abstract ePoster Gallery-When Supportive Care Isn't Enough: Persistent Norovirus Infection in a Transplant Patient

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This case highlights chronic norovirus infection in a 65-year-old woman with a deceased-donor kidney transplant who presented with one month of persistent watery diarrhea, abdominal cramping, dehydration, acute kidney injury, and severe hypokalemia. Workup showed positive stool norovirus PCR, while testing for C. difficile, ova and parasites, and other GI pathogens was negative. CT abdomen/pelvis and colonoscopy were unrevealing.<br /><br />She was taking tacrolimus, mycophenolate mofetil, and prednisone. During hospitalization, she required aggressive IV fluids and electrolyte replacement. Because persistent norovirus is more common and more severe in solid-organ transplant recipients due to impaired cell-mediated immunity, her mycophenolate was held and nitazoxanide was started. Her stool frequency, hydration, and electrolyte abnormalities gradually improved.<br /><br />The poster emphasizes that norovirus is usually a short, self-limited illness in immunocompetent patients, but in transplant recipients it can cause prolonged diarrhea lasting weeks to months, recurrent admissions, dehydration, and kidney injury. Diagnosis requires clinical correlation because norovirus PCR may stay positive even after symptoms improve. Management is challenging because there is no FDA-approved antiviral therapy. Supportive care remains the mainstay, especially fluid and electrolyte replacement. Reducing immunosuppression, particularly mycophenolate, has the best observational support. Nitazoxanide may help and has shown antiviral activity, but evidence is limited.<br /><br />The key takeaway for hospitalists is to recognize chronic norovirus as an important cause of persistent diarrhea in transplant patients so that dehydration, electrolyte derangements, recurrent hospitalization, and progressive kidney injury can be prevented.

Asset Subtitle

Ali Farkhondehpour

Meta Tag

Author List Ali Farkhondehpour, Sandeep Segar

Category Clinical Vignettes

Concept Norovirus

Concept Chronic Diarrhea

Concept Solid Organ Transplant Recipient

Concept Supportive Care

Concept Immunosuppression

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Ali Farkhondehpour

Track Adult

Keywords

norovirus

chronic diarrhea

kidney transplant

solid-organ transplant

immunosuppression

mycophenolate mofetil

nitazoxanide

acute kidney injury

hypokalemia

dehydration

Norovirus

Chronic Diarrhea

Solid Organ Transplant Recipient

Supportive Care

Immunosuppression