Original Works: Case ReportsKidneyLate-Onset Allograft Aspergillosis in an HIV-Positive Renal Transplant Recipient: A Case Report

•Vascular thrombosis of allograft leading to acute kidney injury.•Aspergillus invasion of the renal vessels leading to graft thrombosis and loss.•Localized aspergillus invasion of the allograft without any evidence of dissemination.

Aspergillus infection of the allograft in renal transplant patients is rare and associated with a high mortality. We report a case of a 21-year-old, human immunodeficiency virus-positive, deceased-donor kidney recipient who presented 1 year after transplant with oliguric kidney injury. A nuclear medicine renal scan revealed absence of flow to the transplanted kidney, and a urine fungal culture was positive for Aspergillus flavus. The diagnosis was confirmed with the presence of fungal hyphae along with thrombosis in the vascular structures in renal allograft pathology. We found no evidence of disseminated aspergillosis or involvement of any other organ in the patient. To our knowledge, this case is the first reported in the literature of late-onset non-disseminated renal-limited aspergillosis in a human immunodeficiency virus-positive renal transplant patient.