Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction.

Thumbnail Image



Journal Title

Journal ISSN

Volume Title

Repository Usage Stats


Citation Stats

Attention Stats


Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression.





Published Version (Please cite this version)


Publication Info

Hemmersbach-Miller, M, J Duronville, S Sethi, SE Miller, DN Howell, N Henshaw, BD Alexander, JK Roberts, et al. (2017). Hemorrhagic Herpes Simplex Virus Type 1 Nephritis: An Unusual Cause of Acute Allograft Dysfunction. Am J Transplant, 17(1). pp. 287–291. 10.1111/ajt.14022 Retrieved from https://hdl.handle.net/10161/13102.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



John V Duronville

Assistant Professor of Medicine

Sara Elizabeth Miller

Professor in Pathology

Our laboratory specializes in two areas, infectious diseases, particularlyviral diseases, and ultrastructure-function relationships. Electronmicroscopy (EM) is the focus of the investigative techniques and includes preparative methods such as negative staining, thin sectioning, ultracryomicrotomy and immunolabeling of acrylic and frozen sections.

We are especially interested in methods for diagnosing viral illnesses by EM, and are involved in developing better, more sensitive and faster,methods for detection. While molecular techniques for detecting organisms
are very sensitive, they all require specific reagents, and if the correct probe is not determined a priori, the test is negative. EM offers an open view of any viruses or unsuspected organisms that may be present. We make use of concentration and enhancement methods to increase the chances of
detecting viral agents in fluid specimens. Additionally, we have described a method for selecting small focal areas of pathology in tissue by confocal microscopy to be embedded and examined by EM, increasing the
chances of visualizing organisms. Infectious diseases are the leading cause of death worldwide and the third leading cause in the US. With advanced therapies for cancer patients and many patients living longer
with their disease, a whole new population of infectious disease-susceptible patients has emerged. Chemotherapy, radiation, and bone marrow transplantation are permitting longer survival, but cause
immunosuppression and consequently, strange, unusual diseases, such as polyomavirus infections, sometimes in uncommon body sites. We work closely with physicians to detect and monitor the clearance of
polyomavirus infections in bone marrow and kidney transplant patients. We detect food-borne outbreaks on campus, and we test numerous specimens from patients with infectious diseases. We also serve on the Duke Biodefense Team due to our capability to detect and differentiate poxvirus infections
from those of herpesvirus infections rapidly (within minutes).

Several research collaborations are underway. We have worked with Dr. David Pickup on a structural protein that directs intracellular virus particle movement and maturation. A project with Drs. William Parker and
Randal Bollinger, involves looking at microbes and mucous membrane immunity. It concentrates on biofilms in appendix and lower intestine. We are collaborating with Dr. Meta Kuehn on immunostaining bacterial
vesicles possibly containing endotoxin that have been internalized by
human cells. A different project with Drs. Celia LeBranche and Brian Cullen has examined morphological differences in various retrovirus outer membranes. With Dr. Barton Haynes' laboratory, we determined that cells transfected with single retroviral genes produced subviral particles. With Dr. Michael Hauser's lab, we are examining the difference of myotilin concentration in normal muscle and muscle from muscular dystrophy patients. We worked with a postdoctoral student in the laboratory of Dr. Shirish Shinolokar on staining and examining actin and actin-bundling protein by EM. Finally, we train and assist graduate students, post doctoral students and medical residents how to use electron microscopic techniques in their own studies.


David Noble Howell

Professor of Pathology

A major focus of both my clinical practice and investigative work is the diagnosis and treatment of disorders affecting solid-organ transplant recipients, particularly infectious complications. For the past 15 years, I have served as the primary pathologist for one of the largest lung transplant programs in the world; in the process contributing to over 20 peer-reviewed publications on complications of lung transplantation, including infections, gastroesophageal reflux, tumors, and antibody-mediated rejection; and writing a major book chapter on the subject (Howell DN and Palmer SM, Pathology of the Lung Transplant. 2006. In: Lynch JP, Ross D, eds. Lung and Heart-Lung Transplantation. Marcel Dekker, Inc., New York, pp. 683-722). I have also been the primary pathologist for Duke's renal and liver transplant programs, authoring or co-authoring a wide variety of journal articles and a book chapter in these areas (e.g., Plumb et al., Transplantation 2006;82:1224-1224; Snyder et al., Am. J. Respir. Crit. Care Med. 2010;181:1391-1396).

A second major area of interest is the pathogenesis of renal glomerular diseases. In collaboration with members of the Division of Nephrology at Duke, I have helped assemble and characterize a large registry of patients with familial focal segmental glomerulosclerosis (FFSGS)(Conlon et al., Kidney Int. 1999;56:1863-1871). Analysis of one of the families in this registry led to the discovery at Duke, in the laboratory of Dr. Michelle Winn, of mutations in the TRPC6 cation channel as a cause of FFSGS (Winn et al., Genomics 1999;58:113-120; Winn et al., Science 2005;308:1801-1804). We are continuing to collect data on additional families with focal segmental glomerulosclerosis. In addition, I have served as principle consultative pathologist for several investigators working in animal models of renal disease and transplantation (e.g., Crowley et al., Hypertension 2010;55:99-108).

Finally, I have devoted considerable time and energy to applications of correlative microscopy to diagnostic pathology, with particular emphasis electron microscopy. I am currently President of the Society for Ultrastructural Pathology, an international organization that promotes the use of ultrastructural examination in both diagnostic pathology and clinical and basic research. Much of my published work in this area involves the role of electron microscopy in the diagnosis of renal diseases (e.g., Howell et al., Ultrastruct. Pathol. 2003;17:295-312; Pavlisko and Howell, Ultrastruct. Pathol., in press), but I have also written extensively, with my colleague Dr. Sara Miller, on the ultrastructural diagnosis of infectious disorders, contributing, among other things, to the first description of a new polyomavirus-induced skin disorder, trichodysplasia spinulosa (Haycox et al., J. Investig. Dermatol. Symp. Proc. 1999;4:268-271).


Nancy Gail Henshaw

Assistant Professor of Pathology


Morphology and pathogenesis of Pneumocystis carinii, rapid viral diagnosis, particularly in the immunocompromised host.

Most of my research efforts are of an applied nature which involves adapting new methods of rapid viral diagnosis and testing those newer approaches against standard virological procedures. Validated new tests are incorporated into the standard work-up of appropriate virological specimens. Ultimately the expanded offerings result in a chargeable test for the laboratory. For example as monoclonal antibodies have become available for common respiratory viruses causing lower respiratory tract disease, we have expanded our Respiratory Viral Battery FA and perform that routinely on appropriate specimens as opposed to only performing a RSV FA. We also now charge for Toluidine Blue O staining for Pneumocystis carinii, which I modified and standardized for our lab.

I am also doing an ongoing epidemiological study of adenovirus subtypes in cases of disseminated infection in SCIDs patients. Some of the typing was done by Molly Rivadeneira, M.D. when she rotated through our laboratory. We now have 12 patients in this study.

Also I am studying the morphology and staining characteristics of Pneumocystis carinii when exposed to Calcofluor, a fluorescent brightener that stains cellulose and chitin. In addition to examining laboratory strains, isolates of P. carinii from DUMC patient material is currently being studied. We now have 14 patient isolates in this study.


Barbara Dudley Alexander

Professor of Medicine

Clinical research related to infectious complications of solid organ and bone marrow transplantation, with a particular interest in the treatment and rapid diagnosis of fungal disease. Training the next generation of Transplant Infectious Disease Physicians is a special focus of mine as the Principal Investigator of our Interdisciplinary T32 Training Program funded the NIH. 


John Keith Roberts

Associate Professor of Medicine

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.