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

Abstract

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.

Case report: An unusual case of multisite embolism in a patient with adenovirus pneumoniae

“…Thrombosis associated with adenovirus pneumoniae is extremely rare, especially among immunocompetent adults. Only a few cases showed extrapulmonary manifestation of adenovirus as disseminated intravascular coagulation ( 15 ) or thrombotic microangiopathy ( 16 ). We demonstrated a case of left ventricular thrombus, pulmonary embolism and multisite embolism, including cerebral embolism and artery embolism, in a patient with adenovirus pneumoniae.…”