case_images: PMC8087480_01
case_images: Graft biopsy: (a) microthrombosis in peritubular capillary. (b) Interstitial arteriole with a thrombus and endothelial edema. (c) Thrombosis in glomerular capillaries with retraction of glomerulus and pseudoincrease of urinary space. (d) Peritubular capillaritis due polymorphonuclear leukocytes. (H&E and magnification x40). (e) C4d negative in peritubular capillaries (40x).
case_images: CRIT2021-9933354.001.jpg
case_images: PMC8087480_01_CRIT2021-9933354.001.jpg
case_images: fig1
case_images: Histological findings were thrombotic microangiopathy (TMA), C4D negative, and inflammatory infiltration of polymorphonuclear leukocytes inside peritubular capillaritis; humoral acute rejection was suspected based on these findings (Figure 1).
case_images: Evolution of graft function (SrCr) during antirejection treatment. Yellow arrows show plasmapheresis (days 8, 10, 12, 15, 17, and 19); green, rituximab (day 14); and purple, IG-IV treatment (days 9, 11, 13, 16, 18, and 20).
case_images: CRIT2021-9933354.002.jpg
case_images: PMC8087480_01_CRIT2021-9933354.002.jpg
case_images: fig2
case_images: The treatment choices are plasmapheresis (6 doses), intravenous immunoglobulin (6 doses 0.2 mg/kg), and in the middle (between 3 and 4 dose), rituximab 375 mg/m2 (Figure 2).