Kang Y N, Oh H K, Chang Y C, Kim H-C, Lee S L, Hwang M, Park K-K
Department of Pathology, Keimyung University School of Medicine, Daegu, Republic of Korea.
Transplant Proc. 2006 Jun;38(5):1346-7. doi: 10.1016/j.transproceed.2006.02.100.
Herpes simplex virus (HSV) infection usually occurs in immunocompromised or severely debilitated patients. It is not so common in patients with renal transplants. The diagnosis can only be made histologically. It usually occurs during or shortly after treatment of graft rejection with high-dose steroids. We have recently experienced a case of HSV esophagitis and nephropathy in the renal allograft biopsy, which was identified by histology, immunostaining, and electron microscopy. A 43-year-old woman underwent cadaveric renal transplantation with cyclosporine and prednisolone treatment. Twelve months later, she developed renal insufficiency and proteinuria. Allograft renal biopsy showed some evidence of acute rejection. She was treated with 3 successive days of methylprednisolone (1.0 g/d) intravenously and continued tapering of steroids. Three weeks after steroid pulse therapy, she had throat pain, oral cavity ulcer, dysphagia, and febrile sensation. Esophagoscopy revealed multiple confluent ulcers in the whole esophagus, and biopsy showed enlarged epithelial cells with prominent nuclei. Immunohistochemically, the epithelial cells were positive with a monoclonal antibody to HSV type 1. She was started on acyclovir intravenously, which was continued for a week. After a week, her symptoms began to improve and repeat endoscopy showed no residual esophagitis. A renal allograft infection with HSV can persist in heavily immunosuppressed patients with recurrent rejection episodes. HSV mainly affects tubular cells causing necrosis, a major reason for functional deterioration. A biopsy is required for diagnosis.
单纯疱疹病毒（HSV）感染通常发生在免疫功能低下或极度虚弱的患者中。在肾移植患者中并不常见。诊断只能通过组织学检查做出。它通常发生在使用大剂量类固醇治疗移植排斥反应期间或之后不久。我们最近在一例肾移植活检中遇到了HSV食管炎和肾病的病例，通过组织学、免疫染色和电子显微镜检查得以确诊。一名43岁女性接受了尸体肾移植，并接受环孢素和泼尼松龙治疗。12个月后，她出现肾功能不全和蛋白尿。移植肾活检显示有急性排斥反应的迹象。她接受了连续3天静脉注射甲泼尼龙（1.0 g/d）治疗，并继续逐渐减少类固醇剂量。类固醇脉冲治疗3周后，她出现咽痛、口腔溃疡、吞咽困难和发热感。食管镜检查发现整个食管有多个融合性溃疡，活检显示上皮细胞肿大，细胞核突出。免疫组化显示，上皮细胞对单纯疱疹病毒1型单克隆抗体呈阳性。她开始静脉注射阿昔洛韦，持续了一周。一周后，她的症状开始改善，重复内镜检查显示无残留食管炎。在重度免疫抑制且有反复排斥反应发作的患者中，肾移植感染HSV可能会持续存在。HSV主要影响肾小管细胞，导致坏死，这是功能恶化的主要原因。诊断需要进行活检。
