title: Adenovirus infection of the renal allograft with sparing of pancreas graft function in the recipient of a combined kidney-pancreas transplant.
abstract: We report a case of adenovirus infection of the renal allograft in a combined kidney/pancreas transplant recipient. The clinical presentation was renal allograft failure, which eventually reversed. The pancreatic graft function remained stable. A renal biopsy showed massive tubular necrosis associated with a prominent granulomatous reaction. The process had a striking regional distribution within the kidney with the injury and inflammation limited to the outer medulla. Adenovirus type 11 was isolated from renal tissue by culture, and adenovirus was demonstrated by immunofluorescence and electron microscopy in the kidney biopsy. Immunosuppression may result in unusual patterns of response to infectious agents. This case demonstrated tropism of the adenovirus to only selected tubules within the kidney, with sparing of other organ function including, specifically, the pancreas allograft. The differential diagnosis of a granulomatous reaction in the transplant kidney must be expanded to include viral infection, in particular, adenovirus.
authors.affiliation: Department of Pathology, State University of New York Health Science Center, Syracuse 13210, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Mathur
authors.forename: E C
authors.initials: EC
authors.lastname: Squiers
authors.forename: A H
authors.initials: AH
authors.lastname: Tatum
authors.forename: F S
authors.initials: FS
authors.lastname: Szmalc
authors.forename: J W
authors.initials: JW
authors.lastname: Daucher
authors.forename: D M
authors.initials: DM
authors.lastname: Welker
authors.forename: P F
authors.initials: PF
authors.lastname: Shanley
mesh_terms: D000258:Adenovirus Infections, Human / Q000150:complications* / Q000473:pathology; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003930:Diabetic Retinopathy / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000821:virology; D007674:Kidney Diseases / Q000175:diagnosis; D016030:Kidney Transplantation / Q000473:pathology; D007684:Kidney Tubules / Q000648:ultrastructure; D008854:Microscopy, Electron; D010179:Pancreas / Q000473:pathology / Q000821:virology; D016035:Pancreas Transplantation / Q000473:pathology; D011183:Postoperative Complications / Q000821:virology*