1 infec 64 - tabish60102

[ArchivalUser]

A 41-year-old man, who underwent cadaveric renal transplantation 3 months ago for end-stage renal disease, is seen for a follow-up visit. He is asymptomatic and has good urine output. Current medications are tacrolimus, mycophenolate mofetil, and prednisone. Both donor and recipient were seronegative for cytomegalovirus antibodies.

On physical examination, temperature is 36 °C (96.8 °F), pulse rate is 82/min, respiration rate is 16/min, and blood pressure is 142/86 mm Hg. Cardiopulmonary examination is normal. Abdominal examination is normal. The donated kidney is palpable and nontender. A still-functioning arteriovenous fistula is in the left arm. The extremities are otherwise normal.

Laboratory Studies
Hemoglobin

12.8 g/dL (128 g/L)
Hematocrit

38%
Leukocyte count

6300/μL (6.3 × 109/L)
Platelet count

220,000/μL (220 × 109/L)
Blood urea nitrogen

43 mg/dL (15.36 mmol/L)
Serum creatinine

2.8 mg/dL (247.58 µmol/L) (was 1.2 mg/dL [106.1 µmol/L] 1 month ago)
Serum electrolytes

Normal
Liver chemistry studies

Normal
Urinalysis

200 mg/dL protein; negative glucose; 20“30 leukocytes/hpf with transitional cells containing intranuclear inclusions; 20“40 erythrocytes/hpf; no casts or crystals
Urine cultures

Negative

Which of the following organisms is most likely causing this patient's deteriorating renal function?

A Polyomavirus BK
B Polyomavirus JC
C Human herpesvirus-6
] D Cytomegalovirus
E Human papillomavirus

[ArchivalUser]

dd??

[ArchivalUser]

is it ddd

[ArchivalUser]

Correct Answer = A)
Key Points

* Polyomavirus BK is associated with nephropathy and deteriorating renal function in renal transplant recipients.
* The presence of intranuclear inclusions in tubular epithelial cells or transitional cells is highly indicative of polyomavirus BK.

Deteriorating renal function caused by worsening nephropathy in the absence of other causes is typical of polyomavirus BK infection in renal transplant recipients. The presence of intranuclear inclusions in tubular epithelial cells or transitional cells is highly indicative of polyomavirus BK. Finding the virus on immunochemical studies of renal biopsy specimens confirms the diagnosis.

Polyomavirus JC may cause multifocal leukoencephalopathy but not graft rejection in renal transplant recipients. Human herpesvirus 6 may cause hepatitis and meningoencephalitis but is not known to cause nephropathy in transplant recipients. Cytomegalovirus infection may be associated with deteriorating renal function, but the presence of transitional cells in the urine makes polyomavirus BK much more likely. None of the human papillomaviruses is known to cause nephropathy or rejection of transplanted organs.