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Kidney Week

Abstract: PO2112

Disseminated Adenovirus Infection in a Kidney Transplant Recipient

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Maturostrakul, Boonyanuth N., Northwell Health, New Hyde Park, New York, United States
  • Nair, Vinay, Northwell Health, New Hyde Park, New York, United States
  • Bijol, Vanesa, Northwell Health, New Hyde Park, New York, United States
  • Abate, Mersema, Northwell Health, New Hyde Park, New York, United States
  • Bhaskaran, Madhu C., Northwell Health, New Hyde Park, New York, United States
  • Epstein, Marcia, Northwell Health, New Hyde Park, New York, United States
  • Nair, Gayatri Devi, Northwell Health, New Hyde Park, New York, United States
  • Teperman, Lewis, Northwell Health, New Hyde Park, New York, United States
  • Jang, Hye Jeong, Northwell Health, New Hyde Park, New York, United States
  • Lau, Lawrence, Northwell Health, New Hyde Park, New York, United States
Introduction

Adenovirus as an opportunistic pathogen can cause infections in immunocompromised hosts. Cases of disseminated adenovirus infection in renal transplant patients have been described to be detrimental.

Case Description

28 year-old male with end stage renal disease from focal segmental glomerulosclerosis with 2 prior failed renal transplant on hemodialysis received a 3rd renal transplant from a deceased donor. Though initially planned for thymoglobulin induction, was switched to Basiliximab due to anaphylaxis during thymoglobulin infusion. Patient received plasmapharesis, IV immuglobulin and rituximab in view of his sensitized status and presence of donor specific antibodies with persistent elevated creatinine early post-transplant. Subsequent allograft biopsy showed Banff 1B rejection. He was treated with steroids and Alemtuzumab. Patient was discharged, but was readmitted with high fever. Blood and urine cultures were negative. Respiratory viral panel was positive for Adenovirus. Due to persistent high fever, immunosuppression was minimized. Hydronephrosis was drained with the nephrostomy. Repeat allograft biopsy was performed for rising creatinine. Light microscopy revealed severe necrotizing tubulitis with numerous basophilic nuclear viral inclusions and extensive polymorphonuclear inflammation consistent with adenoviral nephritis. Immunohistochemistry confirmed positive nuclear staining for adenoviral antigens. Patient was found to have moderate pericardial effusion and bilateral ground glass opacities. He was treated with Cidofovir, IV immunoglobulin and reduced immunosuppression. Due to persistent allograft dysfunction, he was maintained on dialysis. At the time of this report patient continues to be on dialysis.

Discussion

Adenoviral infection in healthy individual is often self-limited, rarely requiring more than symptomatic treatment. However, in immunosuppressed individuals it can lead to severe multisystem disease. In this patient, adenoviral infection following robust immunosuppression for early severe allograft rejection led to severe injury to allograft and near fatal illness. A high level of suspicion and prompt treatment can help improve the patient outcome.