ACUTE CYTOMEGALOVIRUS GASTRITIS AFTER REN AL-TRANSPLANTATION - DIAGNOSIS BY POLYMERASE CHAIN-REACTION, ANTIGENEMIA ASSAY AND IMMUNOHISTOCHEMISTRY

To diagnose possible cytomegalovirus (CMV) infection in a 64-year-old man after renal transplantation, polymerase chain reaction (PCR), pp65 antigenaemia assay (pAA) and virus isolation in cell culture were rou tinely performed on a weekly basis. The PCR obtained virus DNA in peri pheral blood lymphocytes for the first time in the fifth week. Two wee ks later the patient complained of feeling unwell with abdominal pain and vomiting on eating. Two days later he developed a fever of up to 3 8-degrees-C and nocturnal sweats. Gastroscopy revealed marked antral g astritis which histologically showed typical cytomegalic >>owl-eye<< c ells. The pAA was clearly positive and the cell culture started in the fifth week now showed a cytopathogenic effect. CMV gastritis having b een diagnosed treatment consisted of 175 mg ganciclovir intravenously twice daily for 10 days. He became symptom-free after two days. The on ly side effects were thrombocytopenia down to 67,000/mul and a rise in transaminase activities, changes which regressed later. To ensure ear ly diagnosis and treatment of any CMV infection, specific virus diagno stic tests should be routinely undertaken after transplantation of org ans from CMV-positive persons into CMV-negative patients.