Kidney Res Clin Pract  
Disseminated adenovirus infection in a 10-year-old renal allograft recipient
Bora Lee1, Eujin Park2, Jongwon Ha3, Il Soo Ha4, Hae Il Cheong4, Hee Gyung Kang4
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
2Department of Pediatrics, Hallym University Medical Center, Seoul, Korea
3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
4Division of Nephrology, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Hee Gyung Kang
Division of Nephrology, Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail: kanghg@snu.ac.kr
ORCID: https://orcid.org/0000-0001-8323-5320
Received: May 28, 2018; Revised: August 6, 2018; Accepted: August 16, 2018; Published online: October 12, 2018.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Disseminated adenovirus infection can result in high mortality and morbidity in immunocompromised patients. Here, we report the case of a 10-year-old renal allograft recipient who presented with hematuria and dysuria. Adenovirus was isolated from his urine. His urinary symptoms decreased after intravenous hydration and reduction of immunosuppressants. However, 2 weeks later he presented with general weakness and laboratory tests indicated renal failure necessitating emergency hemodialysis. Adenovirus was detected in his sputum; therefore, intravenous ganciclovir and immunoglobulin therapy were initiated. Renal biopsy revealed diffuse necrotizing granulomatous tubulointerstitial nephritis compatible with renal involvement of the viral infection. Adenovirus was detected in his serum. Despite cidofovir administration for 2 weeks, adenovirus was also detected in the cerebrospinal fluid, resulting in generalized tonic-clonic seizure. The patient died 7 weeks after the onset of urinary symptoms. Adenovirus should be considered in screening tests for post-renal transplantation patients who present with hemorrhagic cystitis.
Keywords: Adenoviridae, Kidney transplantation, Opportunistic infections, Pediatrics


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