Dr Sanjana Dang1,2, Dr Sridevi Govindarajulu1,2, Dr Alok Gupta1,2, Dr Nyi Aung1,2, Dr Krishna Echampati1,2, Dr Alice Lee1,2
1Toowoomba Base Hospital, Toowoomba, Australia, 2University of Queensland, St Lucia, Australia
Background: Lymphocytic choriomeningitis virus (LCMV) is a zoonotic infection found in rodents. It causes aseptic meningitis with a mild clinical course in immunocompetent adults, but can cause meningoencephalitis with higher mortality in the immunosuppressed. LCMV became of epidemiological significance in the Darling Downs, Queensland during the mouse plague in 2021. A regional study showed eight patients; including a renal transplant recipient; who were found to have LCMV polymerase chain reaction (PCR) positivity on cerebrospinal fluid (CSF) culture. It has previously been described as a donor-derived infection in solid organ transplant (SOT) recipients, however, to our knowledge, there is only one described case of infection due to mouse exposure in this population.
Case report: We describe a 73-year-old male farmer who is an immunosuppressed renal transplant recipient that presented to hospital with fevers, myalgias, generalised malaise and diarrhoea. Investigation for opportunistic infection revealed cytomegalovirus PCR positivity with negative histopathology from colonoscopy. He remained febrile despite anti-cytomegalovirus therapy. Further investigation showed serum cryptococcal antigen positivity (1:32) with nodular changes on chest radiography. He received two weeks of antifungal treatment while awaiting bronchoscopy and CSF culture, both subsequently negative for cryptococcus. The patient’s symptoms spontaneously resolved thereafter and he was discharged home. Due to emerging prevalence, a retrospective CSF LCMV PCR was performed and he was diagnosed with LCMV infection (CSF differential: protein 2600mg/L, leukocytes 111×10^6, glucose 3.4mmol/L). He is currently well in the community.
Conclusions: Atypical infection remains an important cause of febrile illness in SOT recipients. This case demonstrates an unusual virus of epidemiological and environmental significance and serves as a reminder to include evaluation of these factors in our assessment of unwell transplant recipients.
Biography:
Dr Sanjana Dang is a first-year Advanced Trainee in Nephrology, currently placed at Toowoomba Base Hospital in Queensland.