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The significance of tubuloreticular inclusions as a marker of systemic
stimulation by interferons in a case of focal and segmental glomerulosclerosis
associated with cytomegalovirus (CMV) infection
#MMPMID25852866
Bromfield M
; McQuillan R
; John R
; Avila-Casado C
Clin Kidney J
2014[Apr]; 7
(2
): 174-8
PMID25852866
show ga
The identification of large numbers of tubuloreticular inclusions (TRIs) in renal
biopsies may be useful to raise diagnostic suspicion for certain clinical
entities, particularly autoimmune diseases and viral infections. We report a case
of a 65-year-old female with a 2-week history of malaise, massive proteinuria and
lower extremity edema of acute onset. A renal biopsy was performed and the
diagnosis of non-human immunodeficiency virus (HIV) tip-located, early focal
segmental glomerulosclerosis (FSGS) was established. The electron microscopy
examination was remarkable for the presence of diffuse foot process effacement
and frequent TRIs in the endothelial cells of the glomerular capillary loops,
endothelium of arterioles and cytoplasm of fibroblasts in the interstitium,
highly suggestive of an underlying etiology. Patient clinical and laboratory
workup revealed the absence of an autoimmune disease but the presence of a
subclinical cytomegalovirus (CMV) infection. Therefore, we highlight that the
identification of TRIs is a useful indicator of systemic interferon activity. In
the present case, the unusual location of numerous TRIs was associated with a
subclinical CMV infection in an immunocompetent patient.
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