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Abstract: TH-PO978

Collapsing Focal Segmental Glomerulosclerosis and Diffuse Infiltrative Lymphocytosis Syndrome with Renal Involvement in Acute HIV Infection

Session Information

Category: Trainee Case Report

  • 1204 Podocyte Biology

Authors

  • Malik, Erum Z., Temple University School of Medicine, Philadelphia, Pennsylvania, United States
  • Johnstone, Duncan B, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
Introduction

Human Immunodeficiency Virus (HIV) infects and damages podocytes leading to HIVAN, a collapsing form of focal and segmental glomerulosclerosis. HIV also causes dysregulation of the immune system, which rarely can cause CD8+ T-cells to infiltrate and attack various organs, leading to Diffuse Infiltrative Lymphocytosis Syndrome (DILS). We present the first case of simultaneous HIVAN and DILS with renal involvement, occurring only 6-8 weeks after infection during the initial phase of acute HIV seroconversion.

Case Description

A 20 year old Hispanic male was diagnosed with acute HIV based on known exposure, negative serology, and positive p24 antigen. Three weeks later, he was admitted with fever, chills, myalgias, severe dry mouth, neuropathic pain of both legs, and declining urine output. Compared to labwork three weeks prior, new labs showed seroconversion of HIV, a 10-fold increase in CD8+ T-cells, new hyponatremia (123 mEq/L), and renal failure (creatinine 5.24 mg/dL, prior 0.98). Urinalysis showed 300+ protein (while oliguric). Sonogram showed bilaterally enlarged and echogenic kidneys suggestive of interstitial nephritis. He denied using any medications including herbals. Biopsy showed collapsing FSGS with severe interstitial inflammation, and staining demonstrated these were CD8+ T-cells. He started steroids, losartan and anti-retrovirals. His symptoms of xerostomia and neuropathy improved daily, along with an increase in urine output.

Discussion

This report is the first to describe both HIVAN and DILS simultaneously, and of additional significance, both conditions arose early at the time of HIV seroconversion. HIVAN typically occurs in advanced HIV as an AIDS defining illness but was reported twice in early HIV.
DILS is a multi-organ disorder of increased, dysregulated CD8+ T-cells that infiltrate one or more organs, most often the salivary glands and lungs. When kidneys are affected, DILS shows similarities to allergic interstitial nephritis (enlarged and echogenic kidneys, tubular proteinuria, interstitial infiltrate on biopsy), but with DILS the cells are CD8+ T-cells. Renal and extra-renal symptoms of DILS can respond to HAART and prolonged steroids.