Abstract: SA-PO0111
Severe Tubular Injury Secondary to Biopsy-Proven Viral Invasion by Human Herpesvirus 6
Session Information
- AKI: Clinical Diagnostics and Biomarkers
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Abilmona, Dayana, MedStar Health, Columbia, Maryland, United States
- Allam, Krishna C, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Ding, Yanli, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Lobo, Angie S., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Murray, Sean, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Karam, Sabine, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Introduction
Human herpesvirus 6 (HHV-6) infection occurs in immunocompromised patients, often in the setting of allogeneic hematopoietic stem cell transplant (HSCT) and manifests with rash, colitis, myocarditis, hepatitis, encephalitis and meningoencephalitis. When this infection is complicated by acute kidney injury (AKI), it is usually attributed to drug toxicity, rhabdomyolysis, hemodynamic changes or sepsis.
Case Description
A 73-year-old gentleman with a past medical history significant for coronary artery disease, hypertension, type 2 diabetes and myeloproliferative neoplasm with secondary JAK2+ myelofibrosis presented with severe AKI and a creatinine (Cr) level at 4.25 mg/dL (baseline 0.8- 1mg/dL) along with isolated fever of unclear origin on day 29 post-HSCT. He was hemodynamically stable, and his fever resolved promptly after initiation of cefepime. HHV-6 viremia was found (103,185 copies/mL) prompting initiation of ganciclovir therapy. He became anuric with a Cr that peaked at 9.45 mg/dL. A kidney biopsy showed acute tubular injury (ATI) with mild chronic changes of the parenchyma, including focal global glomerulosclerosis (6% of glomeruli), focal tubular atrophy and interstitial fibrosis (5-10% of the cortex). He received 5 sessions of hemodialysis (HD) then his urine output (UO) and kidney function started to improve. The number of HHV-6 copies/mL decreased to 1406, and he completed two weeks of ganciclovir. However, his UO started declining again, HD was restarted and two days after stopping ganciclovir his viremia was found to be 20 081 copies/mL. Viral therapy was restarted, with subsequent AKI resolution and the patient was taken off HD. Kidney biopsy tissue sent thereafter for viral staining, isolated HHV-6 antigen in the tubular epithelium.
Discussion
To our knowledge, the presence of HHV-6 in renal tissue has only been described twice. The first was in the setting of drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms with granulomatous tubulointerstitial nephritis requiring steroid therapy. The second was in kidney transplant recipients. This is the first case of isolated ATI due to HHV-6 invasion in a patient with HSCT, severe enough to warrant HD. Prompt detection and prolonged anti-viral therapy might improve the prognosis.