A rare manifestation of CMV disease in a kidney transplant recipient.

A 46 year old woman with end stage kidney disease due to adult polycystic kidney disease underwent living unrelated donor kidney transplant with bilateral native nephrectomies. This was ABDR HLA 6/6 mismatch transplant with flow cross match negative for T and B cells, despite a Donor Specific Antibody (DSA) against DQ7 being present. She received 4 doses of Thymoglobulin (1.5 mg/kg) and was maintained on Belatacept, mycophenolate mofetil and prednisone. She was matched for Epstein-Barr virus (+/+) and mismatched for Cytomegalovirus (CMV, Donor positive Recipient negative) and received planned 6 months of prophylaxis with Valganciclovir (900 mg once a day, dose-adjusted based on renal function).Of note, patient had a history of cryotherapy for abnormal pap smear, bilateral ovarian cysts, tubal ligation, and endometrial ablation (six years prior to transplantation) for uterine fibroids.