Background: Adenovirus is an important cause of infections in imunocompromized patients. In particular, adenovirus infection is one of the most severe viral infection in renal transplant recipients and can cause graft loss because of adenovirus induced nephritis. We report a case of adenovirus infection of urinary tract after kidney transplantation
Case Description: A 57-year-old man, who received deceased donor kidney transplantation in 13th December, 2015. On the postoperative day (OPD) 3, the urine output was about 10,000cc and the serum creatinine was dropped to normal range (1.26 mg/dL). The recipient was diagnosed by biopsy proven cellular rejection in 23th December, 2015 and received with steroid pulse therapy. Renal function stabilized after treatment. Maintenance immunosuppression induced tacrolimus 0.75mg daily, mycophenolate mofetil (MMF) 750mg twice daily, and methylprednisolone 10mg daily. Seven months after transplant, the patient presented with a fever and hematuria. Initial laboratory data revealed normal chemistries and blood counts except for blood urea nitrogen 29 mg/dL and creatinine 1.84 mg/dL. His tacrolimus level was acceptable at 3.3 ng/mL. Pertinent findings on urinalysis were 2+ protein, and 3+ blood, with microscopy demonstrating red blood cells too numerous to count. A renal sonogram showed a normal resistive index. Results of polymerase chain reaction (PCR) tests for BK, herpes, EBV, and cytomegalovirus were all negative. However, cystoscopy revealed hemorragic cystitis and urine culture test for adenovirus was positive. Reduction of immunosuppression and intravenous gammaglobulin(IVIG) and levofloxacin was started. 9 days after initiation of treatment, the symptom of patients was improved and renal function stabilized with a creatinine of 1.31mg/dL.
Conclusion: This case demonstrates the importance of early detection, as treatment options involve reduction of immunosuppression, followed by the supportive care in kidney transplant recipient with adenovirus infection.