We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR. 1. Introduction In the scenario of transplantation, infection with adenovirus is more common after bone marrow transplantation and affects children more commonly than adults (31–47% versus 13.6%) with an estimated mortality of 26% in symptomatic patients [1, 2]. Adenovirus infection, particularly with serotypes B 7, 11, 34, and 35, presents more frequently as hemorrhagic cystitis and is usually a rare and limited infection in renal transplant recipients [3]. A disseminated disease with more serious systemic complications or death is uncommon (58% of cases are self-limited). Throughout the literature there have only been a small number of case reports of adenoviral-related nephritis in kidney transplant recipients [2–10]. In this report, we describe two unusual cases of early onset infection with adenovirus, as well as a review of previous cases reported in the literature. 2. Case 1 A 26-year-old man with end-stage renal disease of undetermined etiology received a living donor renal transplantation on February 2012. The adult donor was his sister sharing 1-haplotype; the AHG-CDC cross match was negative, the PRA
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