Cytomegalovirus Reactivation in Postrenal Transplant Patients Immediately in Association with Coronavirus Disease 2019 (COVID-19) Infection: A Case Report of 2 Patients and a Brief Review of the Literature

Introduction: The coronavirus disease 2019 (COVID-19) infection has been associated with multiple opportunistic infections, including secondary cytomegalovirus (CMV) reactivation. Several cases of CMV syndrome and invasive CMV infection have been reported following severe COVID-19 infection worldwide during the COVID-19 pandemic in both immunocompetent and immunosuppressed patients. A case-control study conducted in India showed that during the first and second waves, CMV was the most common co-infection among fatal cases of severe COVID-19 lung infection in Indian renal transplant recipients. Case Presentation: We present 2 cases of CMV disease in postrenal transplant patients who developed clinical manifestations of CMV co-infection after mild COVID-19 infection during the fourth wave of COVID-19 infection in India. In both cases, CMV infection was treated by discontinuing mycophenolate mofetil and administering ganciclovir injections. However, the treatment resulted in 2 contrasting clinical outcomes: cure and death. Conclusions: We reviewed the recent literature on the increased incidence of CMV reactivation after both COVID-19 infection and vaccination in immunocompetent and immunocompromised populations. Subsequently, we discussed some clinical questions relevant to the population of postrenal transplant recipients after the detection of mild COVID-19 infection.