| 活体肝移植后巨细胞病毒感染患者骶尾会阴部疼痛的特殊症状
Seisuke Sakamoto, Kaoru Taira, Kohei Ogawa, Yasutsugu Takada, Hiroto Egawa, Koichi Tanaka Transplantation & Immunology, Kyoto University, Kyoto, Japan
Background Cytomegalovirus (CMV) is one of the most popular opportunistic viruses after liver transplantation, and has a diversity of clinical presentation, such as pneumonia, enteritis, and retinitis.
Patients & Methods We experienced four cases of CMV infection with sacroperineal pain after living donor liver transplantation (LDLT). All of them were adults, from 19 to 50 years old, and two females and two males. Their original diseases of LDLT consisted of two cases of primary biliary cirrhosis (PBC), one case of fulminant hepatic failure of unknown origin, and one case of biliary atresia. The pre-transplant (pre-Tx) CMV serology showed three cases were positive and one case was negative. The immunosuppressants were instituted with steroid and calcinurin inhibitors, which consisited of tacrolimus for three cases and cyclosporine for one case. Despite the combination of pre-Tx CMV status between donor and recipient, oral administration of aciclovir was started for viral prophylaxis after transplant.
Results These patients started to present severe sacroperineal pain without any other symptoms suspect of CMV infection on post-operative days 28 to 40. Two cases had the episode of acute cellular rejection prior to the onset of this symptom. One was treated with steroid pulse therapy, and the other needed OKT3 therapy. Any other examinations, such as radiological, orthopedic, and gynecological studies, didn't reveal particular findings. This severe sacroperineal pain could not be well controlled with medications, and one of them needed epidural anesthesia. In the first three cases, CMV antigenemia showed positive, and then intravenous administration of ganciclovir was instituted. On the other hand, in the last case, preemptive ganciclovir was administered before
positive CMV antigenemia was confirmed. After administration of ganciclovir, this pain gradually disappeared, and all of the cases turned to show negative CMV antigenemia. No one has had any sequelae related to CMV infection.
Conclusions We experienced four cases of CMV infection with sacroperineal pain after LDLT. This unusual pain should remind us of the possibility of CMV infection.
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