title: Disseminated adenovirus infection in renal transplant recipients: the role of cidofovir and intravenous immunoglobulin.
abstract: Disseminated adenovirus (ADV) infection in solid organ transplant patients is associated with high mortality. Limited studies have shown benefit from using cidofovir (CDV), as well as intravenous immunoglobulin (IVIG). In this study, we report 2 renal transplant patients who presented with fever and pulmonary infiltrates. Both patients continued to worsen despite antibiotic therapy. Bronchoalveolar lavage viral culture and serum polymerase chain reaction (PCR) were positive for ADV. Patients were treated with CDV, IVIG, and reduction in immunosuppression. A progressive decline in serum ADV DNA by PCR correlated with clinical improvement and pulmonary infiltrates improved. Both patients recovered. Allograft function was preserved although reversible acute kidney injury was observed in both patients. To the best of our knowledge, this is the first successful use of CDV and IVIG in renal transplant patients with disseminated ADV infection.
authors.affiliation: Baylor Transplant Institute, Baylor University Medical Center, and Dallas Nephrology Associates, Dallas, Texas 75246, USA. rehana.saquib@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Saquib
authors.forename: L B
authors.initials: LB
authors.lastname: Melton
authors.forename: A
authors.initials: A
authors.lastname: Chandrakantan
authors.forename: K M
authors.initials: KM
authors.lastname: Rice
authors.forename: C W
authors.initials: CW
authors.lastname: Spak
authors.forename: R D
authors.initials: RD
authors.lastname: Saad
authors.forename: A Z
authors.initials: AZ
authors.lastname: Fenves
authors.forename: Y M
authors.initials: YM
authors.lastname: Barri
mesh_terms: D000256:Adenoviridae / Q000235:genetics / Q000302:isolation & purification; D000258:Adenovirus Infections, Human / Q000188:drug therapy* / Q000821:virology; D000998:Antiviral Agents / Q000008:administration & dosage*; D000077404:Cidofovir; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir