Late cytomegalovirus disease with atypical presentation in renal transplant patients: case reports.

Cytomegalovirus (CMV) disease typically occurs 1 to 4 months (median 35 days) after solid organ transplantation. Recent reports documented that the natural history of CMV disease associated with solid organ transplantation has been modified as a result of the widespread use of potent immunosuppressents and antiviral prophylaxis. We herein report three pretransplant CMV seropositive recipients (with unknown donor status) who were diagnosed recently to display late and atypical CMV disease. Two men and one woman included two patients who presented with allograft dysfunction at 12 years and at 3 years after transplantation. Both patients showed increased serum creatinine approximately from baseline 200 to >400 micromol/L over 3 months in the absence of features of rejection or cyclosporine toxicity. A renal biopsy was refused by both patients. Two of the three patients presented with symptoms of enterocolitis (diarrhea, nausea, weight loss), which had persisted for more than 6 months. Other symptoms and signs of overt CMV disease (fever, leukopenia) were absent. None had pulmonary, hepatic, or other major organ involvement. In all patients IgG antibodies and CMV DNA by polymerase chain reaction were positive with negative IgM antibodies. The immunosuppressive regimen consisted of mycophenolate mofetil (MMF), steroids, and calcineurin inhibitors. The kidney function significantly improved in both patients with renal dysfunction. Gastrointestinal symptoms resolved completely with gradual weight gain. The recognition and early diagnosis of late atypical CMV disease in kidney transplant patients presenting with allograft dysfunction and/or other organ systems is important. The MMF has a red herring effect in our cases due to its GI side effects.

A clinical study of airborne allergens in the United Arab Emirates.

BACKGROUND: In the past 25 years the United Arab Emirates (UAE) have experienced a socioeconomic boom. The once nomadic Bedouin population of Al Ain, in the emirate of Abu Dhabi, now lives in modern air-conditioned accommodation, and huge desalination plants have allowed afforestation and farming. OBJECTIVE: To evidence responsible airborne allergens in an UAE population. PATIENTS AND METHODS: 263 UAE Nationals who attended Tawam Hospital (Al Ain, UAE) with a respiratory disease suspected of being of allergic origin, were submitted to SPT and RAST. The choice of pollinic allergens was made in accordance with the local flora and market availability. All patients were SPTed with at least the same battery of 15 pollinic and indoor allergens. Most patients were submitted to at least 4 RAST, viz Cynodon dactylon, Salsola kali, Prosopis juliflora and Dermatophagoides pteronyssinus. RESULTS: 71.8% patients were positive for at least one allergen. Pollen accounted for 61.6% of positive patients, with 45.2% positive to chenopodiaceae, 33% to gramineae and 23.5% to P. juliflora. Indoor allergens were positive in 30.4% of patients with 17.9% positive to D. pteronyssinus and D. farinae, 11% to Blatella germanica, 8.3% to Cat fur, 4.9% to Goat hair, 0.7% to Rat hair and Mouse hair and 1.5% to Candida albicans. CONCLUSION: Pollen was the prominent allergen. There is room, however, for further epidemiological studies possibly with new extracts and RAST specifically designed after the species of the Gulf region.