Friedrichs Nicolaus, Eis-Hubinger Anna-Maria, Heim Albert, Platen Eva, Zhou Hui, Buettner Reinhard
Institute of Pathology, University of Bonn, Bonn, Germany.
Pathol Res Pract. 2003;199(8):565-70. doi: 10.1078/0344-0338-00463.
Adenoviral infections of immunocompetent patients usually present as self-limiting pharyngitis, gastroenteritis, urocystitis, or conjunctivitis. In immunosuppressed patients, development of the illness can be severe, even life-threatening or fatal, and therapeutical intervention is difficult. Previous case reports of adenoviral infections after kidney transplantation have described a symptomatology of hemorrhagic cystitis, fever, renal dysfunction, and rarely fatal systemic dissemination. Here we report on a 46-year-old female renal transplant recipient suffering from adenoviral serotype 35 nephritis of the donor organ 29 days after transplantation. In this case, the main symptoms of the adenoviral infection were high fever and progressive renal failure of the transplanted organ. At the peak of the clinical symptoms, owing to histological and immunohistochemical evaluations of a kidney biopsy, we were able to establish the diagnosis in time so that adequate therapy could be employed. Immunosuppression was reduced and modified, and a self-limiting course of the infection was observed, followed by significant improvement of graft function. Subsequent to histological diagnosis, adenoviral particles were isolated from urine and identified as adenovirus serotype 35. Adenoviral nephritis of the transplanted organ should be considered in the differential diagnosis of persistent anuria after kidney transplantation. Our case highlights the importance of applying all possible diagnostic techniques, including histological evaluation of renal biopsies.
免疫功能正常的患者感染腺病毒通常表现为自限性咽炎、肠胃炎、膀胱炎或结膜炎。在免疫抑制患者中，病情发展可能很严重，甚至危及生命或致命，且治疗干预困难。既往肾移植后腺病毒感染的病例报告描述了出血性膀胱炎、发热、肾功能不全的症状，很少有致命的全身播散。在此，我们报告一例46岁女性肾移植受者，在移植后29天发生供体器官的35型腺病毒肾炎。在该病例中，腺病毒感染的主要症状是高热和移植器官进行性肾衰竭。在临床症状高峰期，通过对肾活检组织进行组织学和免疫组化评估，我们及时做出了诊断，从而能够采用适当的治疗方法。免疫抑制得到了减轻和调整，观察到感染呈自限性病程，随后移植肾功能显著改善。组织学诊断后，从尿液中分离出腺病毒颗粒，并鉴定为35型腺病毒。在肾移植后持续性无尿的鉴别诊断中应考虑移植器官的腺病毒肾炎。我们的病例强调了应用所有可能的诊断技术的重要性，包括肾活检的组织学评估。
