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FIGURE 9-15 (see Color Plate)

FIGURE 9-15 (see Color Plate)

Fine-needle aspirate from patient with intrarenal cytomegalovirus (CMV) infection. A, There are activated and transformed lymphocytes with immature nuclear chromatin and abundant blue cytoplasm that infiltrate the kidney in response to the infection; large granular lymphocytes (NK cells) may be seen as well, but few neutrophils. Similar activated lymphocytes, NK cells, and atypical monocytes can be observed within the peripheral blood. The tubule epithelial cells are virtually never seen to contain CMV inclusions in aspirate material, in contrast to core biopsy specimens. All intrarenal viral infections have a similar appearance, and immunostaining or in situ hybridization is required to identify specific viruses (May-Grunwald Giemsa, original magnification X 80). B, Tubular epithelial cells stained with antibody to CMV immediate and early nuclear proteins in active intrarenal CMV infection. With an immunoalka-line phosphatase method, cytoplasmic and prominent nuclear staining for these early proteins are observed in the tubular epithelium. In very early infection, neutrophils also may have cytoplasmic staining for these proteins (original magnification X 240).

FIGURE 9-16 (see Color Plate)

Numerous eosinophils in an interstitial inflammatory infiltrate. Eosinophils may be diffuse within the infiltrate, but may also be clustered, forming "eosinophilic abscesses," as in this area (hematoxylin and eosin, original magnification X 400). Eosinophils may also be demonstrated in the urine sediment. Drugs most commonly producing acute interstitial nephritis as part of a hypersensitivity reaction include: penicillins, sulfonamides, and nonsteroidal antiinflammatory drugs [6]. The patient had recently undergone a course of therapy with methicillin. The interstitial nephritis may be part of a systemic reaction which includes fever, rash, and eosinophilia.

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