Spontaneous Splenic Infarction Associated with Cytomegalovirus Viremia in an Immunocompromised Renal Transplant Recipient
Sarah Abu Kamal, Sarah Farnand, Caroline Pinkerman, and Abdelrahman Mansour*
ABSTRACT
Splenic infarction is a rare but serious complication of cytomegalovirus (CMV) infection that can present with multiple and often non-specific manifestations. We present a case of splenic infarction in a 34-year-old kidney transplant recipient receiving immunosuppressive therapy who presented with fatigue, abdominal pain, and diarrhea. Imaging revealed multiple splenic hypodensities initially concerning for lacerations but ultimately consistent with nontraumatic subacute splenic infarcts.
Laboratory evaluation showed a positive CMV polymerase chain reaction (PCR) of peripheral blood ( 25,361 IU/mL). A broad infectious, cardioembolic, and hereditary hypercoagulable workup was unrevealing, supporting a diagnosis of CMV-associated hypercoagulopathy leading to thrombus formation and splenic infarction in an immunocompromised host. The patient improved with supportive care, anticoagulation, and valganciclovir and was discharged with multidisciplinary follow-up; he was subsequently lost to follow-up, precluding confirmation of radiographic or virologic resolution.
