What stain would you order to clinch the diagnosis in this transplant patient with AKI?
A CMV stain is required to clinch the diagnosis of CMV nephritis in this transplant case. The image depicts an H&E stained section and reveals a tubule with lymphocytic tubulitis and surrounding interstitial inflammation.
While the first thought with those findings may be acute T-cell mediated rejection, taking a closer look at the tubular epithelium leads to the correct diagnosis as we can see that the cells are enlarged and show enlarged nuclei in which a few demonstrate classic “Owl-eye” nuclear inclusions and viral cytopathic effect consistent with CMV nephritis.
This patient’s immunosuppression was reduced, and appropriate antiviral treatment was initiated.
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