Acute antibody mediated rejection associated with acute herpetic gingiva-stomatitis in kidney transplant patient: A case report

Introduction: Antibody-mediated rejection (AMR) is the most serious cause of renal allograft loss. Most of the acute AMR attacks occur within the first week post-transplant. Subject: In this case report, we present a case of AMR that occurred five months post-transplant in association with acute oral viral infection. This patient had history of bone marrow hypoplasia two months following onset of hemodialysis and was maintained on cyclosporine and prednisolone beside switch to hirudin as anticoagulant. During that period, she also received 6 units of whole blood till she underwent kidney transplant after 2 years on dialysis. The post-transplant course was uneventful till the patient developed severe acute herpetic gingivastomatitis 5 months posttransplant that was associated with abrupt rise of renal chemistry. Biopsy proven AMR showed resistance to treatment with plasma exchange [PE] and Intravenous immunoglobulins. The patient was readmitted to regular hemodialysis unit for 2 months together with minimization of immunosuppressive treatment. Outcome: During routine follow-up investigations, kidney function tests became near to the pre-rejection levels. We discontinued dialysis and re-administered the initial immunosuppressive regimen. Conclusion: This is the first reported case of AMR in association with acute Herpes simplex infection that shows delayed spontaneous recovery.