ABSTRACT
Disseminated adenoviral infection is a serious problem, especially in an immunocompromised host. The disease carries a mortality rate reaching as high as 80%. It is seen most frequently in bone marrow transplant recipients, where it causes pneumonia and disseminated disease. In solid organ transplant recipients it causes graft infection. We report the case of a renal transplant recipient with disseminated adenoviral infection and acute kidney failure requiring dialysis. Reduction of immunosuppression and 1 dose of cidofovir were associated with resolution of viremia and viruria and return of kidney function to near baseline.
Subject(s)
Adenovirus Infections, Human/etiology , Kidney Diseases/virology , Kidney Transplantation/adverse effects , Nephritis/virology , Adenovirus Infections, Human/drug therapy , Adenovirus Infections, Human/pathology , Adenovirus Infections, Human/virology , Aged , Antiviral Agents/therapeutic use , Cidofovir , Cytosine/analogs & derivatives , Cytosine/therapeutic use , Female , Humans , Kidney/pathology , Kidney Diseases/drug therapy , Kidney Diseases/etiology , Kidney Diseases/pathology , Nephritis/etiology , Organophosphonates/therapeutic use , Time FactorsSubject(s)
Hodgkin Disease/pathology , Kidney Transplantation , Lymphoma, B-Cell/pathology , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoproliferative Disorders/pathology , Adult , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Murine-Derived , Antigens, CD/analysis , Antigens, CD20/analysis , Antineoplastic Agents/therapeutic use , CD79 Antigens , Cell Differentiation , Chromosome Deletion , Chromosomes, Human, Pair 6/genetics , Epstein-Barr Virus Infections/pathology , Humans , Immunohistochemistry , Ki-1 Antigen/analysis , Leukocyte Common Antigens/analysis , Lewis X Antigen/analysis , Lymphoproliferative Disorders/genetics , Lymphoproliferative Disorders/metabolism , Male , Postoperative Complications/drug therapy , Postoperative Complications/pathology , Receptors, Antigen, B-Cell/analysis , Rituximab , Treatment Outcome , fas Receptor/analysisABSTRACT
A 59-year-old man with a 30-year history of type 2 diabetes mellitus presented with fatigue, confusion, and weight loss over a 3-month period. He was found to be hypercalcemic (11.8 mg/dL) and dehydrated, and his hypercalcemia improved with intravenous fluids. While in the hospital, he developed hyponatremia, hypoglycemia, and hypotension. He was found to have a subnormal cortisol level of 2.3 microg/dL at baseline, which increased to only 5.6 microg/dL 60 minutes after a 250-microg corticotropin intravenous stimulation test. The patient developed pneumonia and adult respiratory distress syndrome and died of an acute myocardial infarction. During the autopsy, he was found to have lymphocytic hypophysitis with a severe reduction in corticotropin-producing anterior pituitary cells. No malignancy was identified at autopsy. He is the first male patient to be described in the literature who presented with hypercalcemia caused by lymphocytic hypophysitis.
Subject(s)
Diabetes Mellitus, Type 2/complications , Hypercalcemia/complications , Lymphocytes , Pituitary Diseases/diagnosis , Autopsy , Humans , Male , Middle AgedABSTRACT
We report a male neonate who developed severe cyanosis and bradycardia at birth unresponsive to resuscitation. At autopsy he was found to have premature "closure" of the foramen ovale together with transposition of the great arteries and an intact ventricular septum. Reviewing the literature, we found only one case report describing a similar neonate with this lethal combination of cardiac malformations.
