Enteric adenovirus infection in pediatric small bowel transplant recipients

Three of 70 small bowel. transplant recipients were diagnosed with adenovir us enteritis. The biopsies were performed for surveillance in one patient a t 2.7 years after transplantation and in two symptomatic children 1.5 years and 4.5 months after transplantation. In all three patients the characteri stic epithelial. changes were not noted by the primary observers. Two biops ies had been called "suggestive of acute rejection" and both patients had b een so treated. One biopsy had been diagnosed as "regenerative". Once the e pithelial changes were recognized as being viral, confirmation was possible by stool culture in one patient, immunohistochemistry in two patients, or by Lift technique of the H&E sections for electron microscopy. The immune s uppression was reduced and none of the patients developed disseminated infe ction. As in other transplanted organs, such as lung and liver, adenovirus infection may be limited largely to the allograft but can be destructive. E arly recognition of the characteristic changes that are illustrated can lea d to confirmation of the virus and appropriate reduction of immune suppress ion. A mistaken diagnosis of rejection and augmentation of immune suppressi on can lead to viral dissemination and potential fatality.