A rare case of adenovirus infection in post renal transplant patient

Gittwa Vatsaraj Kottangal; Seethalekshmy Vijayan Nalumakkal; Smitha Nalumakkal Vijayan

doi:10.34172/jnp.2022.17226

doi: 10.34172/jnp.2022.17226

Abstract View: 1034

Case Report

A rare case of adenovirus infection in post renal transplant patient

Gittwa Vatsaraj Kottangal ¹^* , Seethalekshmy Vijayan Nalumakkal ² , Smitha Nalumakkal Vijayan ²

¹ Department of Pathology, Aster MIMS Hospitals, Kozhikode, Kerala, India
² Department of Pathology, Amrita Institute of Medical Sciences, Kochi 41, Kerala, India

*Corresponding author: Gittwa Vatsaraj Kottangal, Email: gittwa.vatsaraj@asterhospital.com, drgitwa@hotmail.com

Abstract

Human adenovirus is a linear, non-enveloped, double-stranded DNA virus that can cause opportunistic infections. Typically, adenovirus infections result in self-limiting respiratory, gastrointestinal or ocular infections. However, it can cause severe disseminated disease in immunocompromised patients, especially in post-transplant recipients. In kidney transplant recipients, adenovirus infections have an incidence of up to 4.1%, usually manifested as hemorrhagic cystitis and tubulointerstitial nephritis, in the first three months post-transplant. Renal biopsy shows necrotizing granulomatous interstitial nephritis and other features consistent with the viral infection. Investigations like immunohistochemistry and polymerase chain reaction (PCR) help in confirmation of the diagnosis. Resolution of the disease with the reduction in immunotherapy alone supports the role of immunosuppression as a risk factor for adenovirus infection.

Keywords: Adenovirus, Hemorrhagic cystitis, Immunocompromised, Necrotizing granuloma, Tubulointerstitial

Implication for health policy/practice/research/medical education:

Adenovirus infection though commonly seen in the first three months of the post-transplant period, can occur late. Necrotizing granuloma is a distinctive histological feature of adenovirus infection. A panel of antiviral antibodies (AdV, SV40, CMV and HSV) and C4d are valuable in the differential diagnosis. If a granulomatous inflammation is present in a renal biopsy, adenovirus infection is a possibility in addition to the usual causes like tuberculosis, sarcoidosis, fungal infections, drugs and vasculitis.

Please cite this paper as: Kottangal GV, Nalumakkal SV, Nalumakkal Vijayan S. A rare case of adenovirus infection in post renal transplant patient . J Nephropathol. 2022;11(x):exx. DOI: 10.34172/jnp.2022.xx.

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