P0776 ASSOCIATION OF ADENOVIRUS INFECTION AND ACUTE INTESTINAL GRAFT REJECTION IN ONE CHILD.

Abstract

Introduction: Infection and acute graft rejection are the two main complications of intestinal transplantation. Clinical symptoms could be similar but their therapies are different. Their association has been described notably with CMV infection. We report a case of adenovirus infection associated with acute graft rejection in a child. Methods: Clinical case Results: A. is a 4 years old boy who had an intestinal graft (small intestin + colon) in July 2002 for microvillous atrophy intestinal disease. He has been weaned of parenteral nutrition 4 months later. A first diarrhea due to rotavirus with dehydratation occurs 6 months later. 8 months later he was rehospitalized for an acute diarrhea with fever and severe dehydratation. Blood and stools examinations were negative (bacterial and virus). The diagnosis was done by endoscopy which show ileal ulcerations and at biopsies acute rejection characterised by peri-glandular lymphocyte infiltration and glandular apoptosis associated with adenovirus infection characterized by epithelial intranuclear inclusions confirmed by immunohistochemiatry. Cidofovir treatment and increase immunosuppression was done. Clinical improvement was obtained confirmed by endoscopy. On biopsies adenovirus were no more present as well as by PCR and rejection strongly improved. Conclusion: Association of adenovirus infections and acute intestinal graft rejection has not been yet described. Negative stool examination in case of persistant diarrhea is an indication for endoscopy and biopsies which could be the only examination which allows to confirm the diagnosis of viral infection and/or rejection and to do an appropriate treatment.