J Korean Med Sci.  2010 Oct;25(10):1529-1531. 10.3346/jkms.2010.25.10.1529.

Hemophagocytic Syndrome in a Patient with Acute Tubulointerstitial Nephritis Secondary to Hepatitis A Virus Infection

• Cho E
• Cha I
• Yoon K
• Yang HN
• Kim HW
• Kim MG
• Jo SK
• Cho WY
• Kim HK

• KMID: 2157862
• DOI: http://doi.org/10.3346/jkms.2010.25.10.1529

Abstract

Hepatitis A virus (HAV) infection is generally a self-limited disease, but the infection in adults can be serious, to be often complicated by acute kidney injury (AKI) and rarely by virus-associated hemophagocytic syndrome (VAHS). Our patient, a 48-yr-old man, was diagnosed with HAV infection complicated by dialysis-dependent AKI. His kidney biopsy showed acute tubulointerstitial nephritis with massive infiltration of activated macrophages and T cells, and he progressively demonstrated features of VAHS. With hemodialysis and steroid treatment, he was successfully recovered.

Keyword

Acute Hepatitis A; Acute Kidney Injury; Lymphohistiocytosis, Hemophagocytic

MeSH Terms

Acute Disease
Acute Kidney Injury/diagnosis/therapy
Antibodies, Viral/analysis
Hepatitis A/complications/*diagnosis/immunology
Humans
Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology
Macrophages/immunology
Male
Middle Aged
Nephritis, Interstitial/complications/*diagnosis
Renal Dialysis
T-Lymphocytes/immunology

Figure

• 

  Fig. 1 Histopathological microscopy of the kidney biopsy. (A) Under light microscopy, diffuse edematous interstitium with damaged tubules and infiltration of inflammatory cells are shown. (H&E stain, ×100) (B, C) Immunohistochemistry. Diffuse and patchy interstitial infiltration of CD3- (B) and CD68-positive (C) cells is noted (×200).

• 

  Fig. 2 Hemophagocytosis (arrow) on smears of bone marrow aspiration.

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