A day at the pool

Gastrointestinal side effects affect ~20% of renal transplant recipients [1]. Among such side effects, diarrhoea is common [2] but under-recognized [3]. Diarrhoea may relate to immunosuppressive drugs or infectious complications. The latter may be caused by one of the usual microbial pathogens that also cause gastroenteritis in immunocompetent patients, such as campylobacter, salmonella or viruses. Cytomegalovirus (CMV) colitis, for example, is seen as a cause of diarrhoea, usually within the first one or two post-transplant years. Once these usual suspects have been excluded, the clinician is left with a long differential diagnosis of other causes of diarrhoea in the immunosuppressed host. We describe the interesting case of a 49-year-old renal transplant recipient who presented with an unusual cause of diarrhoea 2.5 years after transplantation.