Therapeutic options in BK virus-associated interstitial

Department of Pathology, Columbia University, New York,New York, USACASE PRESENTATIONA female in her 30s developed renal failure secondary tomixed connective tissue disease-associated immunecomplex glomerulonephritis. Her past medical and familyhistory was otherwise unremarkable. She underwent apre-emptive renal transplantation from her mother,receiving induction with dacluzimab and had anuneventful post-transplant course. Her immunosuppressiveregimen at discharge included prednisone 5 mg daily,mycophenolate mofetil 1000mg twice daily, tacrolimus4 mg twice daily, and prophylaxis with oral gancyclovirand trimethoprim–sulfamethoxazole, atenolol forhypertension, and famotidine, iron and calcium/vitaminD supplements. Her baseline serum creatinine afterthe transplant was 1.5mg/dl.Two years after receiving the transplant, she developedfever and dysuria and was treated for a presumed urinarytract infection (negative urine cultures). Her serumcreatinine during this episode increased to 1.9 mg/dl andremained elevated in this range. Her physical examinationwas unremarkable and her blood pressure was 130/80mmHg. A renal ultrasound did not show any abnormalities.A renal biopsy was performed.RENAL BIOPSY FINDINGS