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Diagnose This 1/29/2024

By Joel Murphy, MD

Jan 29, 2024

What stain would you order to clinch the diagnosis in this transplant patient with AKI?


A CMV stain is required to clinch the diagnosis of CMV nephritis in this transplant case. The image depicts an H&E stained section and reveals a tubule with lymphocytic tubulitis and surrounding interstitial inflammation.

While the first thought with those findings may be acute T-cell mediated rejection, taking a closer look at the tubular epithelium leads to the correct diagnosis as we can see that the cells are enlarged and show enlarged nuclei in which a few demonstrate classic “Owl-eye” nuclear inclusions and viral cytopathic effect consistent with CMV nephritis.

This patient’s immunosuppression was reduced, and appropriate antiviral treatment was initiated.


Quick note: This post is to be used for informational purposes only and does not constitute medical or health advice. Each person should consult their own doctor with respect to matters referenced. Arkana Laboratories assumes no liability for actions taken in reliance upon the information contained herein.