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Diagnosis: Adenovirus Tubulointerstitial Nephritis

Renal allograft involvement for Adenovirus infection is rare and can manifest as necrotizing tubulointerstitial nephritis and space-occupying lesion. The common differential diagnoses include BK and CMV mediated interstitial nephritis for the most part when viral inclusions are present. However, presence of severe necrotizing granulomatous lesions with predominant neutrophilic inflammation would be considered characteristic for Aenovirus (Parasuraman R, et al. Severe necrotizing adenovirus tubulointerstitial nephritis in a kidney transplant recipient. Case Rep Transplant. 2013;2013:969186. [PubMed link]). In our case immunohistochemistry demonstrated positivity for Adenovirus, and negativity for Poliomavirus, Citomegalovirus and Herpes.

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References

• Dawood US, Nelson A, Wu D, Otto S, Russ GR. Disseminated adenovirus infection in kidney transplant recipient. Nephrology (Carlton). 2014;19 Suppl 1:10-3. [PubMed link]
• Florescu MC, Miles CD, Florescu DF. What do we know about adenovirus in renal transplantation? Nephrol Dial Transplant. 2013;28(8):2003-10. [PubMed link]
• Parasuraman R, Zhang PL, Samarapungavan D, Rocher L, Koffron A. Severe necrotizing adenovirus tubulointerstitial nephritis in a kidney transplant recipient. Case Rep Transplant. 2013;2013:969186. [PubMed link]
• Watcharananan SP, Avery R, Ingsathit A, Malathum K, Chantratita W, Mavichak V, Chalermsanyakorn P, Jirasiritham S, Sumethkul V. Adenovirus disease after kidney transplantation: course of infection and outcome in relation to blood viral load and immune recovery. Am J Transplant. 2011;11(6):1308-14. [PubMed link]
• Sujeet K, Vasudev B, Desai P, Bellizzi J, Novoa-Takara L, He C, El-Meanawy A. Acute kidney injury requiring dialysis secondary to adenovirus nephritis in renal transplant recipient. Transpl Infect Dis. 2011;13(2):174-7. [PubMed link]

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