De Novo Cytomegalovirus Colitis in a Donor-Seronegative/Recipient-Seronegative Kidney Transplant Recipient

Cytomegalovirus (CMV) is one of the most frequent microbes linked with kidney transplant recipients. CMV infection is typically classified as CMV virus isolation in any body fluid or specimen. We present a 43-year-old man who underwent a deceased donor kidney transplant with CMV donor-seronegative and recipient-seronegative (CMV D-/R-) status and completed three months of CMV prophylaxis with high-dose acyclovir given his low-risk status. He was admitted for complaints of profuse watery diarrhea and persistent fevers lasting one week in duration. His infectious workup led to a CMV quantitative nucleic acid amplification test (QNAT) polymerase chain reaction (PCR) of 239,977 IU/mL with a biopsy-proven diagnosis of invasive CMV colitis. He was treated inpatient with intravenous ganciclovir for two weeks and then de-escalated to oral valganciclovir until achieving viremia resolution with undetectable CMV QNAT PCR as an outpatient. This case illustrates the importance of the changing epidemiology and clinical presentation of CMV disease in solid organ transplant (SOT) recipients in an era of new immunosuppression regimens and improved CMV disease detection in the early post-transplant period.