Complicated gastrointestinal CMV disease after small bowel transplantation

We report a case of a 52 year old small bowel transplant recipient, with a clinical course complicated by CMV disease. Recipient and donor were CMV-IgG positive. Ganciclovir i.v., followed by valganciclovir was used for CMV-prophylaxis for 100 days. An antilymphocytic induction therapy was performed with Alemtuzumab on days 0 and 1. Immunosuppression was continued with tacrolimus, mycophenolat mofetil, prednisolon. Six months posttransplant the patient presented with CMV tissue invasive disease of the esophagus and stomach, without presence of viremia, tested by quantitative PCR. Treatment with ganciclovir resul…