Adenovirus causing fever, upper respiratory infection, and allograft nephritis complicated by persistent asymptomatic viremia

Transpl Infect Dis. 2014 Aug;16(4):648-52. doi: 10.1111/tid.12248. Epub 2014 Jun 26.


A 20-year-old woman, with renal transplant complicated by recurrence of focal segmental glomerulosclerosis and post-transplant lymphoproliferative disorder, presented nearly 2 years after transplantation with fever, conjunctivitis, and sinus congestion. She was found to have severe adenovirus (ADV)-induced granulomatous interstitial nephritis, confirmed by immunohistochemical staining for ADV in the renal biopsy, without urinary symptoms, hematuria, or laboratory evidence of a change in allograft function. Fever, upper respiratory tract symptoms, and evidence of adenoviral infection in the allograft resolved with decreased immunosuppression and treatment with cidofovir and intravenous immunoglobulin. Creatinine rose during treatment and remained elevated, possibly related to cidofovir nephrotoxicity. Despite therapy and continued reduction in immunosuppression, asymptomatic low-level viremia persisted for a year. In renal transplant patients with ADV infection, allograft involvement should be highly suspected even without overt urinary symptoms or laboratory evidence of allograft dysfunction. Demonstration of allograft involvement may prompt alternative management that could limit continued allograft infection. No clear recommendations exist for management of asymptomatic ADV viremia in solid organ transplant patients.

Keywords: adenovirus; cidofovir; granulomatous interstitial nephritis; immunosuppression; kidney transplant; viremia.

Publication types

  • Case Reports

MeSH terms

  • Adenoviridae / classification*
  • Adenoviridae / isolation & purification
  • Adenovirus Infections, Human / drug therapy
  • Adenovirus Infections, Human / pathology
  • Adenovirus Infections, Human / virology*
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use
  • Cidofovir
  • Cytosine / administration & dosage
  • Cytosine / analogs & derivatives
  • Cytosine / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunocompromised Host
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / therapeutic use
  • Kidney Transplantation / adverse effects*
  • Nephritis, Interstitial / virology*
  • Organophosphonates / administration & dosage
  • Organophosphonates / therapeutic use
  • Respiratory Tract Infections / virology*
  • Viremia
  • Young Adult


  • Antiviral Agents
  • Immunoglobulins, Intravenous
  • Organophosphonates
  • Cytosine
  • Cidofovir