Cytomegalovirus associated superficial venous thrombosis in a renal allograft recipient

Patient M, a 54 year old gentleman, had undergone live emotionally related renal allograft transplantation in 2004. He presented with history of swelling over both his lower limbs associated with redness and pain of 10 days duration. There was associated low-grade fever, recurrent loose stools of 10 days duration. He was found to have anemia (Hb: 10.2 mg/dL), leucocytosis (TLC: 14,200), acute graft dysfunction (Serum creatinine: 5.24 mg/dL). Venous Doppler of the lower limbs revealed thrombosis of the superficial venous system (great saphenous vein) bilaterally. His serum CMV-PCR revealed significant viral load (10,400 copies/mL). Colonoscopic biopsy revealed CMV DNA positivity on immunohistochemistry. He was managed with anticoagulation (low molecular weight heparin for 3 weeks adjusted to the renal dysfunction), antibiotics and intravenous ganciclovir (for 2 weeks). Thereafter, he recieved oral valganciclovir for another 10 weeks. Swelling in the lower limb and pain reduced after 3 weeks and serum CMV-PCR revealed undetectable viral copies after 4 weeks of therapy. Repeat venous doppler for venous thrombosis after 4 weeks revealed recanalised superficial venous system. We attribute the present episode of superficial vein lower limb thrombosis involving both his lower limbs to cytomegalovirus.