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Diagnose This (June 17, 2019)

L. Nich Cossey, MD
By L. Nich Cossey, MD

Jun 17, 2019

Lymphocytic Tubulitis & Inflamation, allograft, renal pathology, Diagnose This!, Arkana Laboratories
Camera information: Calibration= 1.000 Pixels per pixel; Capture format= 1392 x 1040, Full Frame HQ; Gamma= 0.60; Gain= 1.0 x; Exposure= 58.5 ms; Auto exposure= On; Image type= Colour; Shading= (None); Sharpening= Off; Black clip= 10; White clip= 255; Microscope information:

The image shown comes from a kidney transplant patient with a rise in serum creatinine. What is the most likely diagnosis and what immunohistochemical stain would you want to rule out a less common disease sometimes seen in kidney transplants?

 

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The image shows lymphocytic tubulitis and surrounding lymphocytic inflammation. These findings are most commonly seen in acute T-cell mediated rejection (Banff IA or IB). However, BK/Polyoma virus nephritis can show similar findings and viral cytopathic atypia may not be present making an SV40 immunohistochemical stain useful in excluding this etiology.

 

 

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