RESUMEN
Several cases of ureteral obstruction have been reported in stem cell transplant (SCT) patients; however, they were bilateral and concomitant with or preceded by hemorrhagic cystitis. We describe, to our knowledge, a first case of acute unilateral pan-ureteritis caused by BK polyomavirus (BKPyV) in an SCT patient. This case may represent an early phase of BKPyV reactivation. BKPyV infection should be considered as a potential cause of acute unilateral ureteritis even among SCT recipients.
Asunto(s)
Virus BK , Infecciones por Polyomavirus/virología , Trasplante de Células Madre/efectos adversos , Infecciones Tumorales por Virus/virología , Enfermedades Ureterales/virología , Adulto , Humanos , Huésped Inmunocomprometido , Masculino , Infecciones por Polyomavirus/etiología , Infecciones Tumorales por Virus/etiologíaRESUMEN
BK virus is ubiquitous worldwide, with infection usually occurring in early childhood. BK virus replicates prolifically under immunosuppressive conditions, causing inflammation along the genitourinary tract and progressing clinically to hemorrhagic cystitis, ureteral stenosis, and tubulointerstitial nephritis. Most BK virusassociated nephropathy occurs in renal allograft patients after kidney transplantation, although some case reports have described BK virus-associated nephropathy in the native kidney, particularly in patients with human immunodeficiency virus infection. Here we present the case of a 49-year-old male with acquired immunodeficiency syndrome (AIDS) and renal dysfunction with hydronephrosis. The renal biopsy showed tubulointerstitial nephritis with lymphoplasmacytic infiltrates and intranuclear inclusions in the tubular epithelium, which are typical findings for BK virus-associated nephropathy. In addition, immunohistochemical staining revealed that the SV40 large T antigen exhibited a nuclear localization in tubular cells. To the best of our knowledge, this is the first case report of BK virus-associated nephropathy combined with hydronephrosis that was diagnosed by biopsy in a patient with AIDS.
Asunto(s)
Nefropatía Asociada a SIDA/virología , Virus BK/fisiología , Hidronefrosis/virología , Infecciones por Polyomavirus/diagnóstico , Infecciones Tumorales por Virus/diagnóstico , Complejo SIDA Demencia/virología , Nefropatía Asociada a SIDA/patología , Biopsia/métodos , Resultado Fatal , Humanos , Hidronefrosis/patología , Cuerpos de Inclusión Viral/virología , Cuerpos de Inclusión Intranucleares/virología , Virus JC/fisiología , Leucoencefalopatía Multifocal Progresiva , Linfocitos/patología , Masculino , Persona de Mediana Edad , Nefritis Intersticial/patología , Nefritis Intersticial/virología , Células Plasmáticas/patología , Enfermedades Ureterales/virologíaRESUMEN
Ureteral stenosis due to reactivation of the BK virus (BKV) in a state of immunodeficiency is very rare. More common is the appearance of a hemorrhagic cystitis. This report not only shows bilateral ureteral stenosis after bone marrow transplantation, but also presents severe complications as chronic pelvic pain and impaired kidney function as well as irreparable damage to the whole urinary tract leading to nephroureterectomy, subtrigonal cystectomy and orthotopic ileal neobladder. Finally renal transplantation was required. To our knowledge this is the first case in the literature where such a severe course of BKV associated hemorrhagic cystoureteritis is described.
Asunto(s)
Virus BK/fisiología , Trasplante de Médula Ósea/efectos adversos , Cistitis/virología , Infecciones por Polyomavirus/complicaciones , Infecciones Tumorales por Virus/complicaciones , Activación Viral , Adolescente , Niño , Constricción Patológica/terapia , Constricción Patológica/virología , Cistectomía , Cistitis/terapia , Femenino , Trastornos Hemorrágicos/terapia , Trastornos Hemorrágicos/virología , Humanos , Trasplante de Riñón , Nefrectomía , Uréter/cirugía , Enfermedades Ureterales/terapia , Enfermedades Ureterales/virología , Obstrucción Ureteral/terapia , Obstrucción Ureteral/virología , Reservorios Urinarios Continentes , Adulto JovenRESUMEN
Cytomegalovirus (CMV) infection is common in solid organ transplant recipients and accounts for the majority of graft compromise. Major risk factors include primary exposure to CMV infection at the time of transplantation and the use of antilymphocyte agents such as OKT3 (the monoclonal antibody muromonab-CD3) and antithymocyte globulin. It most often develops during the first 6 months after transplantation. Although current prophylactic strategies and antiviral agents have led to decreased occurrence of CMV disease in early posttransplant period, the incidence of late-onset CMV disease ranges from 2% to 7% even in the patients receiving prophylaxis with oral ganciclovir. The most common presentation of CMV disease in transplant patients is CMV pneumonitis followed by gastrointestinal disease. Hemorrhagic cystitis is a common complication following hematopoietic stem cell transplantation. The condition is usually due to cyclophosphamide-based myeloablative regimens and infectious agents. Even in these settings, CMV-induced cases occur only sporadically. Ureteritis and hemorrhagic cystitis due to CMV infection after kidney transplantation is reported very rarely on a case basis in the literature so far. We report here a case of late-onset CMV-induced hemorrhagic cystitis and ureteritis presenting with painful macroscopic hematuria and ureteral obstruction after 4 years of renal transplantation. The diagnosis is pathologically confirmed by the demonstration of immunohistochemical staining specific for CMV in a resected ureteral section. We draw attention to this very particular presentation of CMV hemorrhagic cystitis with ureteral obstruction in order to emphasize atypical presentation of tissue-invasive CMV disease far beyond the timetable for posttransplant CMV infection.
Asunto(s)
Cistitis/virología , Infecciones por Citomegalovirus/complicaciones , Hemorragia/virología , Inflamación/virología , Complicaciones Posoperatorias/virología , Enfermedades Ureterales/virología , Humanos , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
A 48-year-old HIV positive woman presented with urgency, frequency, recurrent cystitis and episodic macroscopic hematuria. Cystoscopy revealed papillary lesions involving most of the bladder. Histology of bladder biopsies revealed human papilloma virus (HPV) associated condyloma acuminata. We discuss the treatment of this rare lesion and review the literature.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/virología , Condiloma Acuminado/virología , Seropositividad para VIH/complicaciones , Papillomavirus Humano 11 , Enfermedades Ureterales/virología , Enfermedades de la Vejiga Urinaria/virología , Femenino , Humanos , Persona de Mediana Edad , Enfermedades de la Vejiga Urinaria/patologíaRESUMEN
Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.
Asunto(s)
Infecciones por Citomegalovirus , Inflamación/virología , Trasplante de Riñón/efectos adversos , Úlcera Cutánea/virología , Enfermedades Ureterales/virología , Ureterostomía , Adulto , Humanos , MasculinoRESUMEN
Cytomegalovirus (CMV) infection has protean presentation among immunocompromised patients, but the urinary tract is rarely involved. We report a case of extensive ureteral necrosis in a renal transplant, 12-year-old patient with typical histological feature of CMV inclusions. The role of CMV was confirmed by immunohistochemical analysis and concomitant CMV DNA detection in peripheral blood leukocytes by polymerase chain reaction analysis. CMV infection can, therefore, be regarded as a possible cause of ureteral necrosis in renal transplant recipients.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Uréter/patología , Enfermedades Ureterales/patología , Enfermedades Ureterales/virología , Niño , Tasa de Filtración Glomerular , Humanos , Trasplante de Riñón/efectos adversos , Masculino , NecrosisRESUMEN
BACKGROUND: Common clinical manifestations of cytomegalovirus (CMV) infection include flu-like symptoms with fever, diarrhea, leukopenia, and elevated liver enzymes. Diagnosis is made by detection of the virus by buffy-coat blood culture or by polymerase chain reaction (PCR) analysis. METHODS: Here we describe two renal transplant recipients who presented with unusual manifestations of CMV disease (cholecystitis and ureteritis). In both patients, no symptoms or signs of systemic CMV infection were present, and they were thought to have other common causes for cholecystitis and ureteral obstruction. RESULTS: Retrospective analysis of peripheral blood by PCR analysis was positive for CMV DNA. Histologic examination of the resected gall bladder and stenotic ureteric segment showed CMV inclusions, confirmed subsequently by in situ hybridization. Thus, we report that CMV infection may present with acute cholecystitis or ureteral obstruction without its classical clinical symptoms. CONCLUSIONS: Because CMV infection is common in transplant patients, the atypical manifestations of CMV should be considered in the differential diagnosis of posttransplant complications. Detection of CMV DNA in the peripheral blood by PCR analysis may help identify these patients.
Asunto(s)
Colecistitis/diagnóstico , Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/aislamiento & purificación , Trasplante de Riñón , Complicaciones Posoperatorias , Enfermedades Ureterales/diagnóstico , Adulto , Colecistectomía , Colecistitis/virología , ADN Viral/sangre , Diagnóstico Diferencial , Femenino , Humanos , Reacción en Cadena de la Polimerasa , Uréter/patología , Uréter/virología , Enfermedades Ureterales/patología , Enfermedades Ureterales/virologíaRESUMEN
This report describes two cases of ureteral stricture in renal graft recipients related to cytomegalovirus (CMV) and human polyoma BK virus (BKV) ureteritis with the same onset characterized by acute graft failure with no clinical signs of systemic viral infections. The histological analysis did not show other causes of graft impairment (i.e. drug toxicity and acute rejection). Ultrasound scan (US) revealed absent or mild hydronephrosis. The diuretic-MAG3 renal scan showed a urinary flow obstruction. The viral genomes were isolated from urine, peripheral blood and graft or ureteral tissues samples. A percutaneous nephrostomy confirmed the stricture, but it restored urine flow only in the graft affected by CMV ureteritis, the association with a specific antiviral therapy probably produced a stable restoration of graft function. In BKV ureteritis,the graft prognosis was poor; graft loss could be due to the progress of BKV nephropathy. A correct differential diagnosis of the etiologic agent responsible for the ureteritis is mandatory, because treatment and outcome of the infection are different.
Asunto(s)
Antivirales/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , Trasplante de Riñón/efectos adversos , Infecciones por Polyomavirus/tratamiento farmacológico , Infecciones Tumorales por Virus/tratamiento farmacológico , Enfermedades Ureterales/tratamiento farmacológico , Adolescente , Virus BK/efectos de los fármacos , Virus BK/aislamiento & purificación , Infecciones por Citomegalovirus/diagnóstico , Quimioterapia Combinada , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Trasplante de Riñón/métodos , Masculino , Infecciones por Polyomavirus/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/virología , Reoperación , Medición de Riesgo , Infecciones Tumorales por Virus/diagnóstico , Enfermedades Ureterales/virologíaAsunto(s)
Infecciones por Citomegalovirus/complicaciones , Trasplante de Riñón , Enfermedades Ureterales/virología , Adulto , Antivirales/uso terapéutico , Creatinina/sangre , Ciclosporina/uso terapéutico , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/patología , Quimioterapia Combinada , Ganciclovir/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/patología , Trasplante de Riñón/fisiología , Masculino , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Oliguria , Complicaciones Posoperatorias , Prednisolona/uso terapéutico , Uréter/patología , Uréter/virología , Enfermedades Ureterales/patología , Urotelio/patología , Urotelio/virologíaRESUMEN
OBJECTIVE: To report early clinical experience with intraurethral instillation of 5-aminolevulinic acid (ALA) for the detection of clinical lesions (condyloma acuminata) and subclinical human papillomavirus (HPV) lesions of the urethra, not visible by conventional endoscopy. SUBJECTS AND SETTING: Eighty-four men with clinical diagnosis of condyloma acuminata were examined for urethral HPV lesions at the Department of Urology, Ludwig Maximilian University, Munich, Germany. METHODS: The anogenital areas of the patients were thoroughly examined using a magnifying glass before and after application of 5% acetic acid. Conventional as well as fluorescence urethroscopy were performed 1 h after topical application of 0.1% ALA for 15 min. A sensitive colour charge-coupled device camera for fluorescence video inspection was used with spectral analysis. Biopsies were taken for histological examination and HPV detection by polymerase chain reaction (PCR). RESULTS: Forty-three of 84 men attending our clinic for condyloma acuminata had clinical HPV lesions of the urethra. Condylomas of the proximal urethra were found by conventional endoscopy in eight patients. Fluorescence urethroscopy detected additional subclinical lesions in 13 men. All lesions were HPV infections of the urethra confirmed histologically or by PCR. In nine of these subclinical urethra lesions low-risk HPV types (HPV6, 11, 34) were found. Four lesions were associated with high-risk types (HPV18, 31,52,58). CONCLUSIONS: Fluorescence urethroscopy is a promising diagnostic procedure for detecting subtle clinical and subclinical HPV lesions of the urethra, that are normally not visualized by conventional endoscopy. Generally, urethroscopy is recommended in all cases of externally visible condylomas of the urethra after therapy.
Asunto(s)
Ácido Aminolevulínico , Condiloma Acuminado/patología , ADN Viral/análisis , Endoscopía/métodos , Papillomaviridae/aislamiento & purificación , Enfermedades Ureterales/patología , Uretra/virología , Adolescente , Adulto , Biopsia con Aguja , Condiloma Acuminado/diagnóstico , Humanos , Instilación de Medicamentos , Masculino , Sensibilidad y Especificidad , Espectrometría de Fluorescencia , Enfermedades Ureterales/virologíaRESUMEN
Although cytomegalovirus (CMV) infection is common in renal transplant recipients, urinary tract involvement has been rare. Only six cases of symptomatic ureteritis have been reported in renal transplant recipients and all within the last five years. We describe an additional four cases of CMV ureteritis. The presentation of CMV ureteritis is obstructive nephropathy often in the absence of systemic illness. Presentation may also mimic allograft rejection with minimal obstructive symptoms. We hypothesize that CMV ureteritis is an emerging complication of CMV disease, possibly due to changes in transplant practice.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/aislamiento & purificación , Trasplante de Riñón , Enfermedades Ureterales/virología , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Uréter/patología , Uréter/virología , Enfermedades Ureterales/patología , Obstrucción Ureteral/virologíaRESUMEN
Cytomegalovirus (CMV) infection is common in patients infected with human immunodeficiency virus. Hemorrhagic cystitis and tubulointerstitial nephritis have been recognized as complications of CMV infection, and these complications lead to hematuria and compromised renal function. We describe a case of CMV infection of the ureters in a child with vertically acquired human immunodeficiency virus infection; the child presented with severe suprapubic pain, and prolonged macroscopic hematuria and intermittent acute renal failure developed subsequently.
Asunto(s)
Lesión Renal Aguda/virología , Infecciones por Citomegalovirus/complicaciones , Infecciones por VIH/complicaciones , Enfermedades Ureterales/virología , Niño , Femenino , Humanos , Inflamación/complicaciones , Inflamación/virología , Enfermedades Ureterales/complicacionesRESUMEN
Polyoma virus infection causes acute interstitial nephritis and ureteral stenosis in humans but has rarely been noted in other species. In the present study, a hitherto unknown polyoma virus was detected in 12 of 57 cynomolgus monkeys after 3 to 11 weeks of immunosuppression given to promote acceptance of renal allografts or xenografts. This virus, termed cynomolgus polyoma virus (CPV), is antigenically and genomically related to simian virus 40 (SV40). The tubular epithelial nuclei of the collecting ducts in the medulla and cortex reacted with an antibody for the SV40 large T antigen and by electron microscopy contained densely packed paracrystalline arrays of 30- to 32-nm diameter viral particles. A polymerase chain reaction analysis of DNA extracted from affected kidneys detected polyoma virus sequences using primers for a highly conserved region of the large T antigen of polyoma virus. Sequence analysis showed 7 base substitutions and 3 to 5 deletions in the 129-nucleotide segment of amplified products, compared with the corresponding portion of SV40, yielding 84% homology at the amino acid level. CPV caused interstitial nephritis in six renal allografts, a xenograft kidney, and six native kidneys. Infected animals showed renal dysfunction and had tubulointerstitial nephritis with nuclear inclusions, apoptosis, and progressive destruction of collecting ducts. CPV was detected in the urothelium of graft ureters, associated with ureteritis and renal infection. Viral infection was demonstrable in smooth muscle cells of the ureteric wall, which showed apoptosis. One animal had diarrhea and polyoma virus infection in the smooth muscle cells of the muscularis propria of the intestine. Spontaneous resolution occurred in one case; no animal had virus detected in tissues more than 3 months after transplantation. Thus, immunosuppression predisposes cynomolgus monkeys to a polyoma virus infection with clinical consequences quite similar to BK virus infection in humans, including renal dysfunction. We also suggest that this may be the pathogenetic basis for the significant incidence of late onset, isolated ureteral stenosis observed in these recipients.
Asunto(s)
Modelos Animales de Enfermedad , Macaca fascicularis/virología , Infecciones por Papillomavirus/virología , Poliomavirus/aislamiento & purificación , Poliomavirus/patogenicidad , Infecciones Tumorales por Virus/virología , Animales , Antígenos Virales de Tumores/genética , Antígenos Virales de Tumores/inmunología , ADN Viral/genética , Enteritis/patología , Enteritis/virología , Huésped Inmunocomprometido , Intestinos/patología , Riñón/patología , Riñón/virología , Trasplante de Riñón/efectos adversos , Microscopía Electrónica , Datos de Secuencia Molecular , Nefritis Intersticial/patología , Nefritis Intersticial/virología , Infecciones por Papillomavirus/patología , Reacción en Cadena de la Polimerasa , Poliomavirus/genética , Infecciones Tumorales por Virus/patología , Enfermedades Ureterales/patología , Enfermedades Ureterales/virologíaRESUMEN
La infección por citomegalovirus (CMV) es la infección viral más frecuente en pacientes trasplantados, pero es muy inusual el compromiso del tracto urinario. Sólo se han informado unos pocos casos de uretritis por CMV en trasplantados renales. En los informes previos la presentación clínica más habitual es nefropatía obstructiva, a menudo en ausencia de enfermedad sistémica, o, algunas veces, puede simular un episodio de rechazo con mínimos síntomas obstructivos. Nosotros describimos un caso más de uretritis por CMV en un paciente trasplantado renal con ureterostomía y una presentación muy inusual caracterizada por síntomas de infección de vías urinarias y ulceración en la boca de la ureterostomía. El número incrementado de informes de ureteritis por CMV en trasplantados renales plantea la posibilidad de un aumento en la incidencia de esta complicación post-trasplante (AU)
Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication (AU)