Division of Nephrology, Department of Internal Medicine, National Kyushu Medical Center Hospital, Chuo-ku, Fukuoka, Japan.
J Nephrol. 2010 Nov-Dec;23(6):738-42.
A 55-year-old woman was admitted to our hospital because of fever and renal impairment. The patient had undergone a tooth extraction 11 months prior to admission. Echocardiography demonstrated vegetation on the mitral valve, and Streptococcus mitis was detected on blood culture. Accordingly, infectious endocarditis (IE) was diagnosed. Renal biopsy showed crescentic glomerulonephritis. Based on the negative staining for immunoglobulins and complement components in immunofluorescence study and lack of dense deposits on electron microscopy, the renal involvement was considered to be of the pauci-immune type. Subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) developed simultaneously following commencement of antibiotic therapy. The intracranial involvement improved by conservative therapy. Antibiotic treatment resulted in gradual control of IE infection and improvement of renal function. A repeated renal biopsy, performed about 5 months after the first biopsy, showed amelioration of glomerular injury and interstitial damage. To our knowledge, our case was the second to report simultaneous developments of both SAH and SDH secondary to IE. We postulate that the glomerular injury was associated with IE. We report here a rare case of IE-associated crescentic glomerulonephritis with complications of SAH and SDH.
一位 55 岁女性因发热和肾功能损害入院。患者在入院前 11 个月接受了拔牙手术。超声心动图显示二尖瓣有赘生物，血培养检出缓症链球菌。因此，诊断为感染性心内膜炎（IE）。肾活检显示新月体性肾小球肾炎。免疫荧光研究阴性染色免疫球蛋白和补体成分，电子显微镜下无密沉积，因此认为肾受累为寡免疫型。开始抗生素治疗后同时出现蛛网膜下腔出血（SAH）和硬脑膜下血肿（SDH）。颅内受累经保守治疗改善。抗生素治疗逐渐控制 IE 感染并改善肾功能。首次肾活检约 5 个月后再次进行肾活检，显示肾小球损伤和间质损伤改善。据我们所知，我们的病例是第二例报告因 IE 并发同时出现 SAH 和 SDH 的病例。我们推测肾小球损伤与 IE 有关。我们报告了一例罕见的 IE 相关新月体性肾小球肾炎并发 SAH 和 SDH 的病例。
