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Case Reports
. 2021 May-Jun;31(3):314-318.
doi: 10.4103/ijn.IJN_344_19. Epub 2021 Jan 27.

Adenovirus-Associated Thrombotic Microangiopathy and Necrotizing Interstitial Nephritis in a Renal Transplant Recipient: A Case Report and Review

Harshavardhan T Sanathkumar  1 , Anila Abraham Kurien  2 , Yashwanth T Raj  1 , Edwin M Fernando  1
Affiliations
Case Reports

Adenovirus-Associated Thrombotic Microangiopathy and Necrotizing Interstitial Nephritis in a Renal Transplant Recipient: A Case Report and Review

Harshavardhan T Sanathkumar et al. Indian J Nephrol. 2021 May-Jun.

Abstract

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.

Keywords: Adenovirus; graft dysfunction; necrotising interstitial nephritis; renal transplant; thrombotic microangiopathy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Massons trichrome stain confirms the presence of fibrin in the glomerular capillaries (arrow) ×400
Figure 2
Figure 2
Dense neutrophilic infiltrate is seen in some areas in the interstitium. They invade and destroy some of the tubules H and E ×200
Figure 3
Figure 3
Rare tubular epithelial cells had a ‘smudged out’ nucleus (arrow) H and E ×400
Figure 4
Figure 4
IHC stain for Adenovirus is positive over some of the tubular epithelial cells
Figure 5
Figure 5
Timeline of events
See this image and copyright information in PMC

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