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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| Autores principales: | , , , , |
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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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| Sumario: | 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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