Sapovirus as an Emerging Pathogen Implicated in Chronic Diarrhea in Post-Solid Organ Transplant Setting: A Brief Report

Diarrhea is common in the post-solid organ transplant setting and can be infectious or noninfectious in origin. Among infectious causes of diarrhea norovirus and Clostridioides difficle have been implicated commonly while mycophenolate mofetil is one of the common noninfectious causes. There have been anecdotal reports of sapovirus as cause of chronic diarrhea in post-solid organ transplant recipients. We report two such cases with sapovirus-associated chronic diarrhea presenting following renal transplant who were diagnosed on stool multiplex polymerase chain reaction (PCR) testing done at our center. A 74-year-old lady, post-renal transplant in 2013, presented with chronic diarrhea and weight loss for 9 months and was diagnosed to have sapovirus and norovirus coinfection on stool multiplex PCR testing. She was successfully treated with nitazoxanide and change in immunosuppression to azathioprine. Another 48-year-old lady with renal transplantation in 2014 presented with 6-month chronic diarrhea with acute worsening and acute kidney injury. Her stool multiplex PCR was also positive for sapovirus. She was also successfully managed with fluid repletion, antidiarrheal, nitazoxanide, and change in immunosuppression to enteric-coated mycophenolic acid. Sapovirus is an emerging cause of post-renal transplant chronic diarrhea. Early recognition is crucial for appropriate management.