CMV’un neden olduğu ciddi akut hemorajik sistitli bir renal transplant olgusu

Needle renal biopsy was performed in a 21-year-old male patient who had a transplanted kidney from his father because of renal allograft dysfunction developing 8 months after transplantation, and macroscopic hematüria developed 8 days after this procedure. Initially an A-V fistula was suspected as the source of hematuria. However there were no findings of A-V fistula on renal duplex sonography and angiography. Systoscopy could not be performed because of the poor general condition of the patient who, in the meantime, was transfused a total of 12 units red blood cells due to a decrease of hemoglobin level from 12 gr/dL to 6.2 gr/dL. A diagnosis of CMV-induced hemorrhagic cystitis was made on the basis of positive CMV-DNA, and intravenous ganciclovir therapy was started. On the 11th day of ganciclovir treatment severity of macroscopic hematuria decreased, and it completely disappeared on the 19th day of treatment. In conclusion CMV-induced acute hemorrhagic cystitis should also be considered in the differential diagnosis of macroscopic hematuria developing in transplanted patients.