A Unique Case of Allograft Adenovirus Nephropathy without Hemorrhagic Cystitis: A Silent Infiltrator Masquerading Rejection

Human adenovirus infection is a rare life-threatening event in immunocompromised patients, postsolid organ transplantation, leading to significant morbidity and mortality. We present a unique case of a 52-year-old male, live-related renal transplant recipient, who developed early-onset acute graft dysfunction in the absence of any other clinical features. Graft biopsy revealed interstitial inflammation with lymphocytes, epithelioid histiocytes, and a few tubulocentric ill-defined granulomas. There were no intranuclear viral inclusions. We opined the biopsy as acute pyelonephritis with presumptive adenovirus interstitial nephritis. Subsequently, serum polymerase chain reaction (PCR) for adenovirus was positive, and the patient was managed with intravenous immunoglobulin, along with lowering of immunosuppression. His posttherapy repeat PCR for adenovirus was negative, and his graft function is improving. We highlight a rare infection with its even rarer clinical presentation.