Evolution of Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits Over a Decade

Infections remain an important cause of morbidity in kidney transplant recipients, particularly in the early post-transplant period. This window coincides with an increased risk of acute rejections. Prompt identification of the cause of graft dysfunction is paramount to ensure good outcomes. This case report presents a 32-year-old male undergoing his second living-related kidney transplantation, complicated by herpes simplex virus-2 (HSV-2) nephritis. Despite favorable initial graft function, he developed odynophagia postoperatively, leading to the diagnosis of HSV-related esophageal ulcers. Subsequent acute graft dysfunction prompted biopsy, revealing HSV-2 related acute tubular injury. Prompt initiation of intravenous acyclovir resulted in graft recovery. This case underscores the importance of considering uncommon viral etiologies in post-transplant complications and highlights the role of timely diagnosis and treatment in preserving graft function.