Diagnose This (April 18, 2022)

This 32-year-old renal transplant recipient had AKI and pneumonia. A recent biopsy had shown borderline changes for TCMR and the patient received pulse steroids. What is your diagnosis?

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This is a CMV IHC stain, showing CMV-positive cells within glomeruli. CMV viral load was four million copies/ml, and bilateral CMV pneumonia was diagnosed. Rare CMV-positive cells had already been seen in the patient’s previous biopsy (picture) within peritubular capillaries and glomeruli two weeks prior.