Simultaneous Cytomegalovirus Disease and Novel Influenza A (H1N1) Pneumonia in a Renal Transplant Recipient

Background: Cytomegalovirus (CMV) causes the most common post-transplant systemic viral infection. During infectious epidemics, such as the outbreak of novel influenza A (H1N1), immunocompromised hosts including transplant recipients may be at greater risk for acquiring disease and may have a more serious course. Case Report: We report on a 65-year-old female renal transplant recipient who underwent pre-transplant desensitization with whole plasma exchange, intravenous immunoglobulin (IVIG), and rituximab and developed simultaneous CMV disease and H1N1 pneumonia. With accurate diagnosis (CMV polymerase chain reaction [PCR] and H1N1 isolation from bronchoalveolar lavage), ganciclovir, oseltamivir and IVIG therapy, and temporary withdrawal of immunosuppression, the patient recovered from the life-threatening infection with preservation of graft function. Discussion: Co-infection with multiple pathogens should always be considered in transplant recipients receiving intensified immunosuppression, especially during outbreaks of large epidemics.