Meehan S M, Josephson M A, Haas M
Departments of Pathology and Nephrology, University of Chicago, Chicago, IL, USA.
Am J Kidney Dis. 2000 Oct;36(4):E27. doi: 10.1053/ajkd.2000.17735.
Granulomatous tubulointerstitial nephritis has rarely been described in renal allografts. Of 1,574 renal allograft tissue specimens obtained from 514 patients in the period 1993 to 1998, we report three cases (0.6%) with interstitial nephritis containing multiple noncaseating granulomas. Biopsy specimen 1 was obtained from a 44-year-old woman with a 6-day history of systemic Candida albicans infection and showed multiple granulomas containing budding yeasts. Biopsy specimen 2 was from a 33-year-old man who presented with miliary spread of Mycobacterium tuberculosis 12 days before the allograft biopsy. Biopsy specimen 3 was from a 23-year-old woman who presented with Escherichia coli urinary infection and bacteremia that was treated with antibiotics for 10 days before the biopsy. Granulomatous inflammation in reponse to infectious agents or drugs in immunosuppressed kidney transplant recipients can rarely give rise to allograft interstitial nephritis that is distinct from acute rejection. To our knowledge, there are no prior reports of granulomatous tubulointerstitial nephritis associated with C albicans and E coli infection or antibiotic therapy in human renal allografts.
肉芽肿性肾小管间质性肾炎在肾移植中鲜有报道。在1993年至1998年期间从514例患者获取的1574份肾移植组织标本中，我们报告了3例（0.6%）伴有多个非干酪样肉芽肿的间质性肾炎病例。活检标本1取自一名44岁女性，其有白色念珠菌全身感染6天病史，标本显示多个含有芽生酵母菌的肉芽肿。活检标本2来自一名33岁男性，其在移植肾活检前12天出现粟粒性播散性结核。活检标本3来自一名23岁女性，其出现大肠杆菌泌尿系统感染和菌血症，在活检前接受了10天抗生素治疗。免疫抑制的肾移植受者对感染因子或药物产生的肉芽肿性炎症很少会引发与急性排斥不同的移植肾间质性肾炎。据我们所知，此前尚无关于人类肾移植中与白色念珠菌和大肠杆菌感染或抗生素治疗相关的肉芽肿性肾小管间质性肾炎的报道。
