Adenovirus tubulointerstitial nephritis presenting as a renal allograft space occupying lesion.
This report describes a case of adenovirus infection in a renal allograft 36 days after transplantation that presented with transient macroscopic hematuria, prominent systemic features and acute renal dysfunction. The patient had persistent high fevers despite broad antibiotic cover. A CT scan demonstrated a new discrete space occupying lesion in the allograft, which was devoid of blood flow on Doppler sonography. A targeted renal biopsy showed florid and focal necrotizing interstitial nephritis with intranuclear tubular viral inclusions. Treatment with ganciclovir and reduction in immunosuppression resulted in a rapid improvement. Immunohistochemistry and electron microscopy confirmed adenovirus infection. This case demonstrates an uncommon presentation of necrotizing adenoviral nephropathy, which should be considered in cases of renal allograft mass lesions.
Department of Nephrology, Austin Health, Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia.
Andy Kim Ho
AK
Lim
Sarah
S
Parsons
Francesco
F
Ierino
D000256:Adenoviridae / Q000302:isolation & purification; D000258:Adenovirus Infections, Human / Q000473:pathology*; D006801:Humans; D007181:Inclusion Bodies, Viral / Q000473:pathology; D016030:Kidney Transplantation; D007683:Kidney Tubular Necrosis, Acute / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000473:pathology / Q000821:virology*; D011183:Postoperative Complications / Q000209:etiology; D014184:Transplantation, Homologous