Abstract
A 61-year-old female was admitted for fever and acute renal failure 6 weeks after receiving a kidney transplant. Her past medical history was notable for CKD stage 5 due to chronic idiopathic tubulointerstitial nephritis. This was diagnosed in 1998 when she presented with an elevated creatinine, sterile pyuria and proteinuria, and underwent native kidney biopsy confirming the diagnosis. She was initially treated with corticosteroids and remained on 5 mg daily of prednisone up until the date of her pre-emptive living related kidney transplant. She had a low-risk immunologic profile with a negative T and B cell crossmatch prior to transplant. Per our center protocol, she received basiliximab for induction, and was maintained on tacrolimus, mycophenolate and prednisone for immunosuppression, with trough FK506 levels ranging between 8 and 12 ng/mL. She was discharged on a standard antimicrobial prophylaxis regimen of trimethoprimsulfamethoxazole and valacyclovir and had a nadir serum creatinine of 1.2 mg/dL following her transplant. Her post-operative course was uneventful until her presentation to the hospital, when she complained of fevers, nausea and vomiting. Her physical examination and
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