Mr. Isaac, 40 years old, has diabetes.

He develops end stage renal failure due to diabetic

nephropathy. He is able to receive a renal transplant. The operation is successful and he
is started on ciclosporin, mycophenolate mofetil and prednisolone immunosuppression to
prevent rejection. When he is discharged, he is also given cotrimoxazole (a mixture of the
anti-bacterial, sulfamethoxazole and trimethoprim) and nystatin (antifungal)
prophylactically. However, 2 months later, he develops an infection. Cytomegalovirus
(CMV) is identified as the cause from his symptoms, chest X-ray and detection of CMV
DNA by polymerase chain reaction test. Mr. Isaac is treated by two methods:
A reduction in his immunosuppression (mycophenolate mofetil treatment is suspended).
This is vital to allow a better immune response to clear the CMV. Close surveillance of
graft function is important during this period.
Specific anti-viral therapy (ganciclovir). Mr. Isaac responds to this therapy and his
symptoms resolve after 6 days.