An Unusual Finding on Endoscopy… A Diagnosis of Inclusion?

A 58-year-old male with a history of chronic hepatitis B virus (HBV) infection, hepatocellular carcinoma, and end-stage renal disease underwent a combined liver and kidney transplant. His hepatocellular carcinoma was diagnosed six months prior to his transplant and was treated with trans-arterial chemoembolization (TACE). His chronic hepatitis B was treated with tenofovir disoproxil fumarate with suppressed HBV viral loads. The immediate post-transplant immunosuppression regimen consisted of mycophenolate mofetil, tacrolimus, and prednisone. The initial prophylaxis regimen included fluconazole, trimethoprim/sulfamethoxazole, and preemptive strategy for high-risk donor/recipient cytomegalovirus (CMV) status (D+/R-) with valacyclovir (goal therapy duration of 6 months).