Allograft adenovirus nephritis accompanied by Crohn's disease in a kidney transplant recipient: a novel case report

Abstract

Excessive immunosuppression after kidney transplantation (KT) is often encountered in patients undergoing therapy for anti-rejection or autoimmune disease that requires further treatment using immunosuppressive medications (IMs), including biologic agents. We report a novel case wherein a kidney transplant recipient developed severe acute allograft injury and hemorrhagic cystitis at 4.5 years after KT due to adenovirus nephritis after treatment with infliximab for Crohn's disease. The diagnosis was made based on adenovirus immunohistochemistry staining and urine polymerase chain reaction tests. The patient was successfully treated by reducing IMs and administration of immunoglobulin even though allograft function was eventually partially recovered. When new immunosuppressive agents, particularly biologic agents, are initiated for other diseases in addition to maintenance IMs, the following points need to be regarded: (1) pay attention to opportunistic infections even in the late phase of KT, and (2) maintain communication with other specialists who prescribe biologics to ensure appropriate administration of IMs.

Keywords: Adenovirus infection; Adenovirus nephritis; Immunosuppressive medication; Infliximab; Kidney transplantation.

Fig. 1

Clinical course. sCr: serum creatinine, LVFX: levofloxacin, CTRX: cefotaxime, MEPM: meropenem, IVIg: intravenous immunoglobulin

Fig. 2

Allograft biopsy findings. A Periodic acid-Schiff stain (100 ×). B Electron micrography (4000 ×). C Immunofluorescence study (40 ×). D Immunofluorescence study (200 ×)