Mazoyer Elodie, Daugas Eric, Verine Jerôme, Pillebout Evangeline, Mourad Nathalie, Molina Jean-Michel, Glotz Denis
Service de Néphrologie, Hôpital Saint-Louis, AP-HP, Paris, France.
Am J Kidney Dis. 2008 Jan;51(1):121-6. doi: 10.1053/j.ajkd.2007.08.025.
In immunosuppressed individuals, such as hematopoietic stem cell transplant recipients, adenoviruses (ADVs) are a well-known cause of morbidity and mortality, with limited treatment options. However, only a few cases were reported in patients with acquired immunodeficiency syndrome (AIDS), and little is known about the relevance of such an infection in these patients with many other concomitant opportunistic infections. We report the case of a 34-year-old man with AIDS presenting with gross hematuria, right flank pain, and acute decrease in kidney function superimposed on chronic kidney disease. His CD4 count was 0/muL despite highly active antiretroviral therapy. A computed tomographic scan showed enlargement of the right renal pelvis. Cystoscopy showed no clots or macroscopic lesions. Urine analysis showed no bacteria or abnormal epithelial cells. ADV was found in viral culture and by using real-time polymerase chain reaction in the patient's urine and later in blood. The renal biopsy specimen showed ADV-related tubulointerstitial nephritis with intranuclear inclusions in tubular cells stained by anti-ADV antibodies, in addition to chronic tubular and vascular changes. The ADV serotype belonged to subgroup B. Cidofovir therapy was contraindicated for this patient; therefore, he was administered intravenous ribavirin. The efficiency of this treatment could not be assessed because he rapidly developed neutropenia and disseminated aspergillosis and died. This case illustrates another cause of acute kidney disease in very immunosuppressed patients with AIDS, probably underdiagnosed.
在免疫抑制个体中，如造血干细胞移植受者，腺病毒（ADV）是发病和死亡的一个众所周知的原因，治疗选择有限。然而，获得性免疫缺陷综合征（AIDS）患者中仅报告了少数病例，对于这种感染在这些伴有许多其他机会性感染的患者中的相关性知之甚少。我们报告一例34岁艾滋病男性患者，表现为肉眼血尿、右侧胁腹疼痛以及在慢性肾病基础上出现的肾功能急性下降。尽管接受了高效抗逆转录病毒治疗，其CD4细胞计数仍为0/μL。计算机断层扫描显示右肾盂增大。膀胱镜检查未发现血凝块或肉眼可见病变。尿液分析未发现细菌或异常上皮细胞。在患者尿液及随后的血液中，通过病毒培养和实时聚合酶链反应发现了腺病毒。肾活检标本显示腺病毒相关的肾小管间质性肾炎，除了慢性肾小管和血管改变外，抗腺病毒抗体染色显示肾小管细胞内有核内包涵体。腺病毒血清型属于B亚组。西多福韦治疗对该患者禁忌；因此，给他静脉注射利巴韦林。由于他迅速出现中性粒细胞减少和播散性曲霉病并死亡，无法评估这种治疗的效果。该病例说明了在免疫抑制非常严重的艾滋病患者中急性肾病的另一个原因，可能未得到充分诊断。
