Very Late-Onset Cytomegalovirus Disease With Pneumocystis jirovecii Pneumonia Coinfection in a Renal Transplant Recipient: A Case Report and Narrative Review of Published Cases.
- 1Department of Medicine Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA rutgers.edu.
- 2Division of Allergy, Immunology, and Infectious Diseases Department of Medicine Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA rutgers.edu.
Abstract
Cytomegalovirus (CMV) infection is a common and serious complication following renal transplantation. It is associated with significant morbidity and mortality. The introduction of preventive measures with antiviral prophylaxis has reduced the incidence in the immediate posttransplant period, but CMV infection continues to be a prominent complication, especially once antiviral prophylaxis is discontinued. A particularly rare entity is "very late-onset" CMV disease, which we defined as occurring 10 or more years after transplantation. We report a case of very late-onset CMV disease presenting 17 years post-renal transplant, complicated by concurrent Pneumocystis jirovecii pneumonia (PJP). We performed a focused narrative review using PubMed for cases of very late-onset CMV disease to document potential risk factors for very late-onset CMV disease. Our narrative review did not show a consistent pattern between the traditional risk factors such as prior rejection, impaired renal function, or changes in immunosuppressive therapy and the development of very late-onset CMV disease. However, an absolute lymphocyte count below 610/μL was present in our patient and may represent an area for further investigation as a potential risk factor for very late-onset CMV disease. Early recognition is crucial, as complications such as CMV-PJP coinfection carry high mortality rates and adversely affect long-term graft and patient outcomes. Clinicians should maintain a high index of suspicion for CMV in transplant recipients regardless of the time elapsed since transplantation.
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BibTeX
@article{wang2026very,
title = {{Very Late-Onset Cytomegalovirus Disease With Pneumocystis jirovecii Pneumonia Coinfection in a Renal Transplant Recipient: A Case Report and Narrative Review of Published Cases.}},
author = {Christian Wang and Susanne O Ajao and Pinki J Bhatt},
journal = {Case reports in infectious diseases},
year = {2026},
month = oct,
doi = {10.1155/crdi/6503116},
url = {https://europepmc.org/article/MED/42953763},
note = {CC BY},
}
RIS
TY - JOUR
TI - Very Late-Onset Cytomegalovirus Disease With Pneumocystis jirovecii Pneumonia Coinfection in a Renal Transplant Recipient: A Case Report and Narrative Review of Published Cases.
AU - Christian Wang
AU - Susanne O Ajao
AU - Pinki J Bhatt
PY - 2026
DA - 2026/10/28
JO - Case reports in infectious diseases
DO - 10.1155/crdi/6503116
UR - https://europepmc.org/article/MED/42953763
AB - Cytomegalovirus (CMV) infection is a common and serious complication following renal transplantation. It is associated with significant morbidity and mortality. The introduction of preventive measures with antiviral prophylaxis has reduced the incidence in the immediate posttransplant period, but CMV infection continues to be a prominent complication, especially once antiviral prophylaxis is discontinued. A particularly rare entity is "very late-onset" CMV disease, which we defined as occurring 10 or more years after transplantation. We report a case of very late-onset CMV disease presenting 17 years post-renal transplant, complicated by concurrent Pneumocystis jirovecii pneumonia (PJP). We performed a focused narrative review using PubMed for cases of very late-onset CMV disease to document potential risk factors for very late-onset CMV disease. Our narrative review did not show a consistent pattern between the traditional risk factors such as prior rejection, impaired renal function, or changes in immunosuppressive therapy and the development of very late-onset CMV disease. However, an absolute lymphocyte count below 610/μL was present in our patient and may represent an area for further investigation as a potential risk factor for very late-onset CMV disease. Early recognition is crucial, as complications such as CMV-PJP coinfection carry high mortality rates and adversely affect long-term graft and patient outcomes. Clinicians should maintain a high index of suspicion for CMV in transplant recipients regardless of the time elapsed since transplantation.
SN - 2090-6625
SN - 2090-6633
ER -