Cytomegalovirus in the transplanted kidney: a report of two cases and review of prophylaxis

Cytomegalovirus (CMV) disease is a leading cause of infectious morbidity and mortality in patients with a kidney transplant. Before the advent of specific prophylaxis and therapy, more than half of the patients who had not been exposed to CMV prior to kidney transplantation developed primary disease and ~20% of patients with prior evidence of exposure developed reactivation disease [1]. Mortality estimates from CMV disease exceeded 30% [2]. Although use of prophylaxis or preemptive treatment of detectable viral load has drastically reduced its burden, CMV remains a common clinical problem with a wide variety of presentations. To highlight the importance of clinical vigilance for CMV even in the current era of effective prophylaxis, we describe two adult kidney transplant recipients with invasive CMV disease. Both patients were diagnosed with CMV disease after they underwent allograft biopsy, which demonstrated the rare finding of CMV inclusions in the kidney allograft.