A case of fever of unknown origin with severe stomatitis in renal transplant recipient resulting in graft loss

We present a case of fever of unknown origin and life-threatening stomatiti s developed about 60 months after renal transplantation. He was 15 yr old a t the transplantation. Bacterial, fungal, and viral infections were not evi dent. Fever and stomatitis were resistant to acyclovir and to any anti-bact erial or anti-fungal treatment. Graft biopsy revealed a small focus of acut e vascular rejection, but the findings were not severe enough to be an etio logy of the fever in this case. The administration of cyclosporine (CYA) wa s stopped 19 d before graftectomy, but the clinical picture was unchanged. Fever and stomatitis was resolved immediately after graftectomy and the dis continuation of immunosuppressants such as mizoribine (MZ) and prednisolone . Pathological changes of the graft included chronic transplant glomerulopa thy, acute glomerulitis, and lymphocyte infiltration in peritubular capilla ries. Thus we suppose that immunosuppressants were the cause of both fever and stomatitis in this case. We speculate that a fever in this case might b e due to the immunosuppresuant itself, i.e. CYA or MZ, or viral infection - probably herpes-simplex virus infection. It is probably the immunosuppress ive state pet se that may cause the resistance of his muco-cutaneous lesion to anti-viral agent.