Sanathkumar Harshavardhan T, Kurien Anila Abraham, Raj Yashwanth T, Fernando Edwin M
Department of Nephrology, Stanley Medical College and Hospital, Kolathur, Chennai, Tamil Nadu, India.
Renopath, Center for Renal and Urological Pathology Private Limited, Kolathur, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2021 May-Jun;31(3):314-318. doi: 10.4103/ijn.IJN_344_19. Epub 2021 Jan 27.
Adenoviral infections, though rare, may be a source of significant morbidity and mortality in the early post renal transplant period. We present a case of fever and graft dysfunction in a deceased donor renal transplant recipient whose initial post-operative period was complicated by vascular thrombosis and ureteric necrosis. He had received induction immunosuppression with Rabbit-Anti Thymocyte Globulin. Graft biopsy was suggestive of Thrombotic Microangiopathy (TMA) accompanied by intense interstitial inflammation, hemorrhage, necrosis, WBC casts and tubular injury. Viral cytopathic changes were discernible on light microscopy, leading to suspicion of adenoviral infection. This was confirmed with immunohistochemical demonstration of adenoviral antigens in the graft biopsy. He was treated with a step down of immunosuppression and intravenous Immunoglobulin. However, the patient's general condition deteriorated rapidly, and he succumbed to his illness. We highlight this association of TMA and necrotizing tubulo-interstitial nephritis with adenoviral infection of the renal allograft.
腺病毒感染虽然罕见，但可能是肾移植术后早期严重发病和死亡的一个原因。我们报告一例死亡供体肾移植受者出现发热和移植肾功能障碍的病例，其术后初期并发血管血栓形成和输尿管坏死。他接受了兔抗胸腺细胞球蛋白诱导免疫抑制治疗。移植肾活检提示血栓性微血管病（TMA），伴有强烈的间质炎症、出血、坏死、白细胞管型和肾小管损伤。光镜下可见病毒细胞病变，怀疑为腺病毒感染。移植肾活检中腺病毒抗原的免疫组化证实了这一诊断。他接受了免疫抑制减量和静脉注射免疫球蛋白治疗。然而，患者的一般状况迅速恶化，最终因病死亡。我们强调了这种血栓性微血管病和坏死性肾小管间质性肾炎与同种异体肾移植腺病毒感染之间的关联。
