Solid organ transplant-associated lymphocytic choriomeningitis, United States, 2011

Abstract

Three clusters of organ transplant-associated lymphocytic choriomeningitis virus (LCMV) transmissions have been identified in the United States; 9 of 10 recipients died. In February 2011, we identified a fourth cluster of organ transplant-associated LCMV infections. Diabetic ketoacidosis developed in the organ donor in December 2010; she died with generalized brain edema after a short hospitalization. Both kidneys, liver, and lung were transplanted to 4 recipients; in all 4, severe posttransplant illness developed; 2 recipients died. Through multiple diagnostic methods, we identified LCMV infection in all persons, including in at least 1 sample from the donor and 4 recipients by reverse transcription PCR, and sequences of a 396-bp fragment of the large segment of the virus from all 5 persons were identical. In this cluster, all recipients developed severe illness, but 2 survived. LCMV infection should be considered as a possible cause of severe posttransplant illness.

Figure 1

Liver from a 62-year-old woman (lung transplant patient) showing acute necrosis of hepatocytes and minimal inflammation. Randomly distributed single-cell necrosis, as observed in this patient, is a histopathologic feature observed in lymphocytic choriomeningitis virus infection. Original magnification ×400.

Figure 2

Immunohistochemical staining of lymphocytic choriomeningitis virus antigens in a biopsy specimen of the transplanted liver from a 60-year-old woman, which demonstrates abundant and predominantly perimembranous staining of hepatocytes. Original magnification ×200.