Post-CMV Organizing Pneumonia - An Unusual Presentation 10 years after Kidney Transplantation.

A 45-year-old gentleman underwent kidney transplantation in March 2010. He remained apparently healthy for the next 10 years when he developed anorexia and weight loss. Diagnostic workup revealed cytomegalovirus (CMV) pneumonia. While viremia resolved within 3 weeks of initiation of valganciclovir, he developed progressive breathlessness and hypoxia on exertion. Imaging of thorax revealed central peri-bronchovascular consolidation and fine reticulations with peripheral sparing. Computed tomography (CT)-guided percutaneous lung biopsy revealed organizing intra-alveolar exudates, suggestive of organizing pneumonia, with no evidence of active infection on biopsy as well as bronchoalveolar lavage (BAL) cytology. This atypical pattern of central distribution of opacities is not typical of organizing pneumonia where peripheral subpleural distribution is more common. Patient responded dramatically following escalation of steroids, with complete resolution of infiltrates on follow-up imaging.

Thrombotic Thrombocytopenic Purpura and Ulcerative Colitis - A Potential Link Revisited.

Inflammatory bowel disease is known to be associated with several extraintestinal manifestations including haematological abnormalities. The association between ulcerative colitis and thrombotic thrombocytopenic purpura is largely anecdotal, described in only two case reports so far. While the existence of association remains a matter of research, what is clear is the need for prompt recognition of this complication and expedient treatment which may be life-saving. Here, we describe a patient with ulcerative colitis who developed thrombotic thrombocytopenic purpura.