Hypereosinophilia in a Patient with Kidney Allograft Dysfunction on Hemodialysis

What is it about?

Eosinophilia (eosinophil count ≥500/µL) is common in hemodialysis patients, often due to infections, dialyzer reactions, or malignancies. We present the case of a woman on hemodialysis for chronic allograft dysfunction who developed hematuria and severe hypereosinophilia 16 months post-dialysis initiation. After excluding usual causes, a 18F-FDG-PET/CT was performed, revealing inflammatory activity in the kidney allograft cortex, suggesting acute rejection. Histopathology confirmed eosinophil-rich chronic active antibody-mediated rejection (cABMR). Blood eosinophil count normalized two weeks after surgery. This case highlights the importance of considering rejection in the differential diagnosis of hypereosinophilia in transplant patient, even after kidney graft failure and hemodialysis resumption.

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