Abstract: FR-PO780
A Case of Hemorrhagic Cystitis Leading to Disseminated Disease from Adenovirus in a Renal Transplant Patient
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Mathew, Neetha, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Fernandez, Sonalis, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Mondal, Zahidul H., Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Puri, Sonika, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Bhagat, Amar Mahesh, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
- Madu, Chioma, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
Group or Team Name
- Rutgers Robert Wood Johnson University Hospital Dept of Nephrology.
Introduction
Adenovirus can cause many infections in immunocompromised hosts including nephritis and hemorrhagic cystitis. It commonly occurs in immunocompromised patients from reactivation of latent infection or primary infection. It is especially concerning in patients with renal transplants. The diagnosis requires the use of multiple diagnostic specimens to detect viral shedding. Diagnosis is also made in the context of clinical manifestations, as in our patient who developed adenovirus infection with hemorrhagic cystitis.
Case Description
This is a 63-year-old woman with a history of ESRD secondary to hypertensive nephrosclerosis status-post DDRT on 9/13/2016. Her post-transplant course was uneventful and she was discharged with a creatinine of 0.7 mg/dl.
She presented to the hospital six years post-transplant with dysuria, urinary urgency, urinary frequency and lower abdominal pain with urination. Her creatinine at this time was 0.6 mg/dL. Her urinalysis showed 37 white blood cells and > 182 red blood cells. She was started on Zosyn for possible pyelonephritis. Her urine culture had no growth and she was discharged on levofloxacin.
She was readmitted about one week later with recurrence of urinary symptoms and hematuria. Her urinalysis showed > 182 red blood cells and her creatinine was 1.6 mg/dL. A CT urogram was done and was unremarkable. Due to her AKI, a renal biopsy was performed which was unable to be analyzed due to an inefficient tissue sample. She was found to be positive for adenovirus PCR DNA and was started on cidofovir and probenecid. Her creatinine normalized to her baseline. She was continued on her immunosuppression regimen of Myfortic, Envarsus and prednisone. She completed treatment for her adenovirus infection after two months with resolution of her symptoms and notable clearance of adenovirus DNA in the serum.
Discussion
Most adenovirus infections are self-limited and treatment is usually supportive. However, adenovirus can be fatal in immunocompromised hosts with high morbidity and mortality. Disseminated adenovirus disease may be preceded by a period of asymptomatic viremia. Thus, the diagnosis can be missed leading to poor outcomes. The early identification of the disease by monitoring viremia has been shown to be beneficial, as we see for CMV infections in immunocompromised patients.