Staphylococcus-Related Glomerulonephritis Mimicking Henoch-Schönlein Purpura and Cryoglobulinemic Vasculitis in a Affected person With an Epidural Abscess: A Case Report and Temporary Assessment of the Literature.
Can J Kidney Well being Dis. 2018;5:2054358118776325
Authors: Mahmood T, Puckrin R, Sugar L, Naimark D
Rationale: Staphylococcus-associated glomerulonephritis (SAGN) is a uncommon immune complex-mediated glomerulonephritis related to lively Staphylococcus an infection. We report a case illustrating the significance of medical historical past and kidney biopsy findings in establishing the proper analysis.
Presenting considerations of the affected person: We report the case of a 64-year-old man with alcohol-associated cirrhosis, sort 2 diabetes mellitus, and hypertension who introduced to hospital with decrease again and belly ache, rectal bleeding, a purpuric decrease extremity rash, and oliguric acute kidney damage with microscopic hematuria and nephrotic-range proteinuria.
Diagnoses: Pores and skin biopsy revealed IgA leukocytoclastic vasculitis. Serum cryoglobulins have been constructive and there was hypocomplementemia with a low C3 stage. Magnetic resonance imaging of the lumbar backbone revealed septic discitis and epidural abscesses brought on by a latest Staphylococcus aureus bacteremia. Kidney biopsy confirmed IgA-dominant and C3-dominant proliferative glomerulonephritis with subepithelial humps in line with SAGN.
Interventions: Pressing hemodialysis was initiated together with a protracted course of intravenous cefazolin.
Outcomes: Remarkably, the affected person demonstrated a whole restoration of renal operate after 2 months of dialysis dependence and profitable therapy of the epidural abscesses.
Classes discovered: This case exhibits that SAGN can intently mimic the medical, laboratory, and histological presentation of Henoch-Schönlein Purpura or cryoglobulinemic vasculitis. Scientific historical past and kidney biopsy, significantly electron microscopic evaluation, are important to establishing the proper analysis to keep away from the pointless and doubtlessly dangerous administration of immunosuppression. Regardless of the usually poor prognosis of SAGN, this case report illustrates that full renal restoration stays doable with supportive care and eradication of the underlying an infection.
PMID: 29900000 [PubMed]