Diarrhea in a post-renal transplant child: Questions

Excerpt

A 14-year-old boy with the status of post-living relative renal transplant presented with a 2-week history of diarrhea and a 3.74-kg weight loss over the previous month. The diarrhea was non-bloody, non-mucous and watery and was associated with generalized malaise and cramping abdominal pain. He denied nausea, emesis, fever or urinary symptoms. His past medical history was complex, including a history of bilateral Wilms tumor diagnosed at age 16 months with multiple recurrences, radiation therapy, subsequent bilateral nephrectomies and living relative renal transplant 20 months before the current presentation. Before his transplant, he tested cytomegalovirus (CMV)-positive and Epstein-Barr virus (EBV)-negative, and the donor was CMV-positive and EBV-positive. There were no documented episodes of graft rejection in the post-transplant period. His medications on admission included tacrolimus 1 mg daily in the morning and 1.5 mg daily in the evening, mycophenolate mofetil (MMF) 750 mg every 12 h and valganciclovir 450 mg once daily. …