Abstract: SA-PO054
Epstein-Barr Virus-Associated Acute Interstitial Nephritis in an Adult Presenting with Chronic Osteomyelitis
Session Information
- AKI: Clinical, Outcomes, and Trials - Management
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Dhillon, Simran, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Abedini, Amin, University of Maryland Medical System, Baltimore, Maryland, United States
- Onder, Songul, University of Maryland School of Medicine, Baltimore, Maryland, United States
Introduction
Epstein Barr Virus (EBV) is a rare cause of acute interstitial nephritis (AIN) in adults.
It is primarily reported in children and young adults. The use of steroids and duration of the steroid use in viral intertitial nephritis is controvertial.
Case Description
45 Year old female with chronic osteomyelitis and open wound presented with fever, hypotension, fatigue, flank/abdominal pain and sore throat. Her past medical history was significant for chronic kidney disease stage 3b due to diabetic nephropathy, with baseline serum creatinine at 2.0 mg/dl. Initial labs revealed acute on chronic kidney failure, with serum creatinine at 4.4 mg/dl, cholestatic hepatitis, leukopenia and anemia. She was started on intravenous vancomycin and piperacillin-tazobactam. EBV IgM was positive with elevated viral load. Bilateral flank pain, AKI and cholestatic liver injury worsened despite discontinuing antibiotics. She was started on hemodialysis (HD). Kidney biopsy revealed extensive interstitial inflammatory infiltrates, Epstein-Barr encoding region (EBER) in situ hybridization positive consistent with EBV associated AIN. She was started on Prednisone 60 mg/day and valganciclovir due to worsening symptoms and renal/liver indices. Her symptoms and renal and liver parameters improved to baseline after 10 days course of Prednisone.
Discussion
We here report fast recovery of EBV-associated AIN with short course of prednisone and valganciclovir. Case reports and retrospective cohorts support the use of corticosteroids and antivirals in addition to supportive care in severe complicated EBV-associated AIN.
The use of corticosteroid for renal recovery had to be balanced against infectious concerns with osteomyeltis, and thus corticosteroid course was discontinued at ten days after greatly improved renal/liver indices, improved clinical symptoms and liberation from HD. Early recognition and timely initiation of corticosteroid treatment may be crucial for favorable outcomes in EBV-AIN requiring HD.
Lab results and renal biopsy