Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report
Abstract: Membranous nephropathy (MN) represents 1.5-9% of cases of nephrotic syndrome in children, and can be primary or secondary. Infectious causes include congenital syphilis, associated or not with other viral infections. Our objective is to present a case of MN in a 2-month-old...
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| Formato: | Artículo revista |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/35071 |
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I10-R327-article-35071 |
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Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
membranous nephropathy membranous glomerulopathy syphilis parvovirus infant nefropatía membranosa glomerulopatía membranosa sífilis parvovirus lactante . |
| spellingShingle |
membranous nephropathy membranous glomerulopathy syphilis parvovirus infant nefropatía membranosa glomerulopatía membranosa sífilis parvovirus lactante . Faure , E E Seminara , C Carranza , G Herrero , M Mukdsi , J H Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report |
| topic_facet |
membranous nephropathy membranous glomerulopathy syphilis parvovirus infant nefropatía membranosa glomerulopatía membranosa sífilis parvovirus lactante . |
| author |
Faure , E E Seminara , C Carranza , G Herrero , M Mukdsi , J H |
| author_facet |
Faure , E E Seminara , C Carranza , G Herrero , M Mukdsi , J H |
| author_sort |
Faure , E E |
| title |
Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report |
| title_short |
Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report |
| title_full |
Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report |
| title_fullStr |
Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report |
| title_full_unstemmed |
Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report |
| title_sort |
membranous nephropathy secondary to syphilis and coinfection by parvovirus b19, with full house immunofluorescence in an infant: a case report |
| description |
Abstract:
Membranous nephropathy (MN) represents 1.5-9% of cases of nephrotic syndrome in children, and can be primary or secondary. Infectious causes include congenital syphilis, associated or not with other viral infections. Our objective is to present a case of MN in a 2-month-old infant with coinfection by Treponema Pallidum and Parvovirus B19, which exhibited a rare immunofluorescence (IF) pattern called full house in reference to the simultaneous detection of deposits of IgA, IgG, IgM, C3 and C1q.
2-month-old female patient with frank hematuria of 48 hours of evolution and positive IgG for COVID-19. The laboratory presented urine with mild pyuria and abundant red blood cells. Proteinuria 122mg/m2/day, index: 5 (nephrotic range). Negative urine culture and normal renovesical ultrasound. The serological study revealed: positive VDRL (1/512) and positive VDRL lumbar puncture. Viral serology: HIV (-), HBV (-), HCV (-), Parvovirus B19 IgM (++++) and IgG (++). Treatment was established with Penicillin G sodium 300,000 IU/kg/day, every 6 hours by e.v.
Renal biopsy was performed: Light Microscopy with mesangial hypercellularity and focal dilatation of the renal tubules. Immunofluorescence: Full house, with granular staining in the glomerular basement membrane for: IgG (++), IgA (+), IgM (++), C3 (++) and C1q (+++). Electron microscopy: thickened glomerular basement membranes with electron-dense immune complex-type deposits on the subepithelial slope and severe pedicellar fusion. With these data, the diagnosis was made: stage I membranous glomerulopathy with a full house pattern.
Currently the patient is in remission of her nephrotic syndrome, with a protein/creatinine ratio of 0.2.
The association between syphilis and renal involvement is well known. However, the congenital form as a cause of NM has been scarcely reported. In addition to this, parvovirus B19 is a cause of lupus pseudo-nephritis, being able to generate a full house pattern in the renal biopsy. The case of coinfection presented here in pediatric age highlights, for clinicians, the importance of having serological tests for these infections in the study of a case of nephrotic syndrome and, for pathologists, requesting all the patient's history and think of bacterial/viral agents as possible generators of rare immunofluorescence patterns.
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| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/35071 |
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I10-R327-article-350712024-04-15T16:19:09Z Membranous nephropathy secondary to syphilis and coinfection by Parvovirus B19, with full house immunofluorescence in an infant: a case report Nefropatía membranosa secundaria a sífilis y coinfección por Parvovirus B19, con inmunofluorescencia full house en una lactante: reporte de un caso A Faure , E E Seminara , C Carranza , G Herrero , M Mukdsi , J H membranous nephropathy membranous glomerulopathy syphilis parvovirus infant nefropatía membranosa glomerulopatía membranosa sífilis parvovirus lactante . Abstract: Membranous nephropathy (MN) represents 1.5-9% of cases of nephrotic syndrome in children, and can be primary or secondary. Infectious causes include congenital syphilis, associated or not with other viral infections. Our objective is to present a case of MN in a 2-month-old infant with coinfection by Treponema Pallidum and Parvovirus B19, which exhibited a rare immunofluorescence (IF) pattern called full house in reference to the simultaneous detection of deposits of IgA, IgG, IgM, C3 and C1q. 2-month-old female patient with frank hematuria of 48 hours of evolution and positive IgG for COVID-19. The laboratory presented urine with mild pyuria and abundant red blood cells. Proteinuria 122mg/m2/day, index: 5 (nephrotic range). Negative urine culture and normal renovesical ultrasound. The serological study revealed: positive VDRL (1/512) and positive VDRL lumbar puncture. Viral serology: HIV (-), HBV (-), HCV (-), Parvovirus B19 IgM (++++) and IgG (++). Treatment was established with Penicillin G sodium 300,000 IU/kg/day, every 6 hours by e.v. Renal biopsy was performed: Light Microscopy with mesangial hypercellularity and focal dilatation of the renal tubules. Immunofluorescence: Full house, with granular staining in the glomerular basement membrane for: IgG (++), IgA (+), IgM (++), C3 (++) and C1q (+++). Electron microscopy: thickened glomerular basement membranes with electron-dense immune complex-type deposits on the subepithelial slope and severe pedicellar fusion. With these data, the diagnosis was made: stage I membranous glomerulopathy with a full house pattern. Currently the patient is in remission of her nephrotic syndrome, with a protein/creatinine ratio of 0.2. The association between syphilis and renal involvement is well known. However, the congenital form as a cause of NM has been scarcely reported. In addition to this, parvovirus B19 is a cause of lupus pseudo-nephritis, being able to generate a full house pattern in the renal biopsy. The case of coinfection presented here in pediatric age highlights, for clinicians, the importance of having serological tests for these infections in the study of a case of nephrotic syndrome and, for pathologists, requesting all the patient's history and think of bacterial/viral agents as possible generators of rare immunofluorescence patterns. Resumen: La nefropatía membranosa (NM) representa el 1,5-9% de los casos de síndrome nefrótico en niños, pudiendo ser primaria o secundaria. Entre las causas infecciosas se encuentra la sífilis congénita, asociada o no a otras infecciones virales. Nuestro objetivo es presentar un caso de NM en una lactante de 2 meses de edad con coinfección por Treponema Pallidum y Parvovirus B19, con una inmunofluorescencia (IF) poco frecuente denominado full house en referencia a la detección simultánea de depósitos de IgA, IgG, IgM, C3 y C1q. Paciente femenina de 2 meses de edad con hematuria franca de 48hs de evolución, piuria e IgG positiva para COVID-19. El laboratorio presentó proteinuria 122mg/m2/día, índice: 5 (rango nefrótico). Urocultivo negativo y ecografía renovesical normal. El estudio serológico reveló: VDRL positiva (1/512) y punción lumbar VDRL positiva. Serología viral: HIV(-), VHB(-), VHC(-), Parvovirus B19 IgM(++++) e IgG(++). Se estableció tratamiento con Penicilina G sódica 300.000 UI/kg/día, cada 6hs por vía e.v. Se realizó biopsia renal: Microscopía Óptica con hipercelularidad mesangial y dilatación focal de túbulos renales. Inmunofluorescencia: Full house, con tinción granular en membrana basal glomerular para: IgG (++), IgA (+), IgM (++), C3 (++) y C1q (+++). Microscopía Electrónica: membranas basales glomerulares engrosadas con depósitos electrodensos de tipo complejos inmunes en la vertiente subepitelial. Con estos datos se diagnóstico: glomerulopatía membranosa etapa I con patrón full house. Actualmente la paciente se encuentra en remisión de su síndrome nefrótico, con un índice de proteína/creatinina de 0.2. La asociación entre sífilis y afectación renal es bien conocida. Sin embargo, la forma congénita como causa de NM ha sido escasamente reportada. Sumado a esto, el parvovirus B19 es una causa de pseudo-nefritis lúpica, pudiendo generar un patrón full house en la biopsia renal. El caso de coinfección aquí presentado en la edad pediátrica resalta, para los clínicos, la importancia de contar con los tests serológicos para estas infecciones en el estudio de un caso de síndrome nefrótico y, para los patólogos, el solicitar todos los antecedentes del paciente y pensar a los agentes bacterianos/virales como posibles generadores de patrones de inmunofluorescencia poco frecuentes. . Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-10-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion texto texto texto https://revistas.unc.edu.ar/index.php/med/article/view/35071 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. Suplemento (2021): Suplemento JIC XXII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. Suplemento (2021): Suplemento JIC XXII Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. Suplemento (2021): Suplemento JIC XXII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |