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Adenovirus Colitis Post-Transplant — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostAdenovirus Colitis Post-TransplantSCE Infectious Diseases

A 40-year-old woman with a recent liver transplant develops diarrhoea on day +30. CMV PCR is negative. Stool multiplex PCR detects Adenovirus. Colonoscopy shows patchy colitis with ulceration. Adenovirus immunohistochemistry on biopsies is positive. What is the management?

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Correct answer: D — Reduce immunosuppression; consider IV Cidofovir if severe or progressive disease

Adenovirus colitis in solid organ transplant recipients is managed primarily by reduction of immunosuppression to allow immune reconstitution against the virus. Cidofovir (a nucleotide analogue with broad anti-DNA virus activity) may be considered for severe or progressive adenoviral disease, though evidence is limited to case series. Ganciclovir has no significant activity against adenovirus. Brincidofovir (oral lipid conjugate of Cidofovir with reduced nephrotoxicity) has been used but has limited availability. Serial adenovirus PCR monitoring guides response.

Reference: NICE NG37 2016 – SOT infections; ECIL-7 2019 – Adenovirus