Infection related membranoproliferative glomerulonephritis secondary to anaplasmosis: A case report.

Maulik K Lathiya, Praveen Errabelli, Salvatore Mignano, Susan M Cullinan
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Abstract

Background: Anaplasmosis is a tick-borne disease with a range of clinical manifestations, from a flu-like illness with fever and myalgias to a severe systemic disease with multisystem organ failure. Although renal involvement is not a common presentation, there have been few cases reporting acute kidney injury from Anaplasmosis.

Case summary: We present a 55-year-old female with anaplasmosis who developed acute kidney injury due to membranoproliferative glomerulonephritis (MPGN). The patient originally presented with cough and shortness of breath. She was admitted to the hospital with a diagnosis of community acquired pneumonia and received antibiotics. During the hospital course she developed severe acute renal failure. Initial serological work up didn't provide any conclusive diagnosis. Hence, she underwent kidney biopsy which showed MPGN pattern suggesting autoimmune, multiple myeloma or infectious etiology. Extensive work up was undertaken which was negative for autoimmune diseases, vasculitis panel, paraproteinemias but tested positive for IgG anaplasma with high titers indicating Anaplasmosis.

Conclusion: Our case shows a unique presentation of severe acute renal failure from MPGN from tick borne illness. MPGN is usually seen with autoimmune diseases, hepatitis C virus infections, paraproteinemias. Hence, we suggest that tick borne illness should also be considered when evaluating acute renal failure cases in tick borne prevalent regions.

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无形体病继发于感染相关膜增生性肾小球肾炎1例。
背景:无形体病是一种蜱传疾病,具有一系列临床表现,从发烧和肌痛的流感样疾病到多系统器官衰竭的严重全身性疾病。虽然肾脏受累不是一个常见的表现,有少数病例报告急性肾损伤的无形体病。病例总结:我们报告一位55岁女性无形体病患者,因膜增生性肾小球肾炎(MPGN)而发展为急性肾损伤。病人最初表现为咳嗽和呼吸短促。她因诊断为社区获得性肺炎而入院,并接受抗生素治疗。在住院期间,她出现了严重的急性肾衰竭。最初的血清学检查没有提供任何结论性诊断。因此,她接受了肾活检,显示MPGN模式,提示自身免疫性、多发性骨髓瘤或感染性病因。开展了广泛的工作,自身免疫性疾病、血管炎、副蛋白血症均为阴性,但IgG无原体检测呈阳性,高滴度表明无原体病。结论:我们的病例显示了一个独特的表现严重急性肾功能衰竭的MPGN从蜱传疾病。MPGN常见于自身免疫性疾病、丙型肝炎病毒感染、副蛋白血症。因此,我们建议在蜱传流行地区评估急性肾衰竭病例时也应考虑蜱传疾病。
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