PMC5762978_01
Kidney biopsy sample containing a virus-infected renal tubule. Most of the renal tubular epithelial cells are lost or damaged beyond recognition. Two of the residual epithelial cells contain "smudged" intranuclear viral inclusions typical of adenovirus, with nuclear enlargement and peripheral displacement of nuclear chromatin (black arrows). There is an associated intratubular and peritubular infiltrate consisting predominantly of distinct histiocytes with elongated, curved, and crinkled nuclei (open blue arrows). Periodic acid-Schiff stain, original magnification x600.
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These cells infiltrated and distended the tubules, many of which contained epithelial cells with nuclear viral inclusions as well as apoptic cells (Figure 1).
Temporal trend of human adenovirus (HAdV) urine polymerase chain reaction (PCR), serum creatinine, and inception of immunotherapy. Discontinuation of mycophenolate mofetil and reduction of tacrolimus goal trough initiated at day 0, i.v. Ig 0.5 g/kg received on days 8 and 9.
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Serum creatinine and urine PCR HAdV DNA levels declined steadily, with return to baseline and resolution, respectively (Figure 2).