title: Concurrent cytomegalovirus glomerulitis and BK polyomavirus-associated nephropathy in a kidney allograft biopsy.
abstract: A 58-year-old renal transplant recipient underwent biopsy 11 weeks post transplantation for increasing creatinine. The biopsy showed cytomegalovirus (CMV) glomerulitis together with BK polyomavirus (BKPyV)-associated nephropathy (PVAN). Treatment with intravenous ganciclovir and overall reduction in maintenance immunosuppression resulted in prompt resolution of the CMV glomerulitis, but with persistence of PVAN in a follow-up biopsy 4 weeks later. Stable creatinine and BKPyV viral clearance were observed at the last clinical visit 15 months post transplantation. This case exemplifies infectious glomerulitis, which requires differentiation from the more common glomerulitis caused by antibody-mediated allograft rejection. The morphological similarities and differences between BKPyV and CMV infections are discussed.
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: I O
authors.initials: IO
authors.lastname: Chikeka
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Paulk
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Haririan
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Papadimitriou
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Drachenberg
mesh_terms: D001739:BK Virus / Q000302:isolation & purification*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D006084:Graft Rejection; D006801:Humans; D016867:Immunocompromised Host; D007668:Kidney / Q000473:pathology / Q000821:virology; D007678:Kidney Glomerulus / Q000473:pathology / Q000821:virology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000473:pathology / Q000821:virology*; D011183:Postoperative Complications; D014019:Tissue Donors; D014412:Tumor Virus Infections / Q000473:pathology / Q000821:virology*
keywords: BK polyomavirus-associated nephropathy; CMV; SV40 stain; glomerulitis; renal biopsy; viremia