Interferon alpha (IFN-a ) can be effective therapy for patients with chronic kidney disease who have chronic hepatitis C (HCV). However, acute allograft rejection has been reported in association with IFN-a following kidney transplantation, and therefore IFN therapy is recommended prior to, rather than after, kidney transplantation whenever feasible. The special case of repeat allograft recipients who contract HCV after the first transplantation presents special difficulties. This report features the case of a repeat allograft recipient who presented with neutropenic fevers after 5 months of pegylated IFN-a therapy, initiated 6 months following the functional loss of his third graft and the reinitiation of hemodialysis (HD). Physical exam, radiographic and laboratory findings led to allograft nephrectomy. The pathologic findings supported a diagnosis of acute-on-chronic rejection. This represents a rare case of IFN-a induced rejection following allograft failure and return to HD in a repeat allograft recipient. It also calls attention to the need for a high index of suspicion for the development of allograft rejection, which may require allograft nephrectomy even after allograft 'failure'. † Both authors contributed equally to first authorship.
The topic of genitourinary diverticulosis will be presented in 2 sequential issues: Part I (Volume 35, No. 12) and part II (Volume 35, No. 13). Part I will cover diverticulosis of the female and male urinary tracts, and part II will cover diverticulosis of the female reproductive system.
After participating in this activity, the radiologist should be better able to diagnose urinary tract diverticular disease in both men and women on the basis of the clinical presentation and imaging findings, and to suggest treatment considerations.
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