Severe tubulo-interstitial disease in a renal allograft due to cytomegalovirus infection.

A 34 year old female developed impaired function of her renal allograft 21 months post-transplant. This was associated with lethargy, pyrexia, tenosynovitis, pancytopenia and a colonic ulcer. Severe tubulo-interstitial changes with intranuclear inclusion bodies and intracytoplasmic herpes type viral particles were seen on renal biopsy. There was no evidence of rejection. Cytomegalovirus was cultured from the urine and there was a rise in CMV antibody titer. These findings suggested the renal impairment was due to a direct cytopathic effect of the CMV. Despite treatment with transfer factor and adenine arabinoside, there was progressive loss of graft function.