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CASE REPORT
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Adenovirus-associated thrombotic microangiopathy and necrotizing interstitial nephritis in a renal transplant recipient: A case report and review


1 Department of Nephrology, Stanley Medical College and Hospital, Kolathur, Chennai, Tamil Nadu, India
2 Renopath, Center for Renal and Urological Pathology Private Limited, Kolathur, Chennai, Tamil Nadu, India

Correspondence Address:
Harshavardhan T Sanathkumar,
Department of Nephrology, Stanley Medical College and Hospital, No. 1, Old Jail Rd, Old Washermanpet, Chennai - 600 001, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_344_19

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.


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    -  Sanathkumar HT
    -  Kurien AA
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