Abstract

In this issue of the Southern Medical Journal, the authors detail a comprehensive description of a case of thrombotic microangiopathy after lung transplantation. A 61-year-old woman who had previously received a single lung transplant for chronic obstructive pulmonary disease was admitted to the hospital with the acute onset of headache and altered mental status. The differential diagnosis was broad, including a cerebrovascular accident, infections, and neurologic adverse effects of her immunosuppressive therapy. Her past history of chronic obstructive pulmonary disease suggested that she was previously a smoker and may have had peripheral or cerebrovascular disease. Indeed, vascular complications are not uncommon problems long-term after lung transplantation because the necessary medical regimen increases the incidence and severity of systemic hypertension, hyperlipidemia, and diabetes mellitus.¹ However, an infection was perhaps the more likely cause of her illness. Cytomegalovirus (CMV) has been called the “troll” of transplantation and remains an important and serious infection after lung transplantation despite various prophylactic regimens. In addition, while CMV does not typically infect the central nervous system, her symptoms may have been nonspecific manifestations of CMV syndrome.