A patient was noted to have rapidly increasing serum creatinine 4 months after receiving a renal allograft. A renal biopsy was performed, which revealed small oval/elongate objects within the renale tubules. (CLICK ON IMAGES TO ENLARGE). A variety of stains and additional studies were performed:
H&E, 1000x (note how tiny the structures inside the renal tubule cells are)
The structures were partially acid fast (Ziehl Neelsen, 1000x)
A Ryan's trichrome performed on tissue nicely highlighted the objects (1000x)
A urine specimen stained with Ryan's trichrome also showed these structures.
By electron microscopy, the objects were seen within vacuoles in the renal tubular cells.
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