Life-threatening adenovirus infection in a kidney transplant recipient

Abstract

Adenovirus causes 5–10% of all childhood febrile illnesses [1]. In the immunocompetent host, infection is usually associated with mild, self-limiting upper respiratory tract syndromes. Most individuals have serologic evidence of prior adenoviral infection by age 10 [1]. Following initial infection, adenovirus establishes lifelong latent infection in lympho-epithelial tissues [2]. In immunocompromised hosts, the spectrum of adenovirus infection can range from asymptomatic shedding to fatal disseminated disease [2]. It may represent primary infection, usually the case in paediatric transplant recipients, or reactivation of latent disease. Latent viruses may be of donor or recipient origin [2]. Adenovirus infection has been documented in solid organ transplantation, but is relatively rare and therefore a paucity of epidemiologic data exists. This case of adenovirus infection in a kidney transplant recipient is unusual for the severity of allograft dysfunction and the life-threatening nature of disease. It highlights the need for consideration of adenovirus as a cause of fever of unknown origin in the post-transplant setting. Potential therapeutic options are discussed, including use of cidofovir in a dialysis-dependent patient.