A case of acute renal failure associated with diffuse infiltrative lymphocytosis syndrome.
BACKGROUND
A 58-year-old African American man with an uncontrolled HIV infection presented to hospital with nephrotic syndrome and diffuse lymphadenopathy. The patient had been taking highly active antiretroviral therapy (HAART; lamivudine, abacavir, fosamprenavir and ritonavir) for 10 years. A renal biopsy showed acute granulomatous interstitial nephritis. Despite a negative tuberculin skin test, he was treated with antituberculosis drugs for 12 months without improvement of his renal profile. Two months after antituberculosis treatment was discontinued, the patient was readmitted to hospital because of acute renal failure. Corticosteroid therapy (prednisone) was started and resulted in a marked improvement in renal function. However, 18 months after steroids were discontinued, renal function declined dramatically. Furthermore, the patient had CD8+ lymphocytosis as well as interstitial tissue infiltration by CD8+ T lymphocytes.


METHODS
Physical examination, plasma HIV viral load, lymphocyte counts, urinalysis, tuberculin skin test, liver function tests, renal ultrasonography, human leukocyte antigen (HLA) typing, renal and minor salivary gland biopsies, ophthalmological examination, chest radiography and culture of bronchoalveolar lavage fluid.


METHODS
Acute granulomatous interstitial nephritis secondary to diffuse infiltrative lymphocytosis syndrome.


RESULTS
HAART and prednisone.
Izzedine
Hassane
H
Department of Nephrology, La Pitié-Salpêtrière Hospital, 47-80 Boulevard de l'Hôpital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France. hassan.izzedine@psl.aphp.fr
Brocheriou
Isabelle
I
Valantin
Marc-Antoine
MA
Camous
Laurent
L
Bourry
Edward
E
Baumelou
Alain
A
Deray
Gilbert
G
Katlama
Christine
C
D058186:Acute Kidney Injury / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D001707:Biopsy, Needle; D004502:Education, Medical, Continuing; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D007677:Kidney Function Tests; D018655:Lymphocyte Count; D008218:Lymphocytosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D018570:Risk Assessment; D012720:Severity of Illness Index; D013577:Syndrome