Xavier-Júnior José Cândido Caldeira, Silva Vanessa Dos Santos, Viero Rosa Marlene
Department of Pathology - Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu/SP - Brazil .
Department of Internal Medicine - Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu/SP - Brazil .
Autops Case Rep. 2015 Sep 30;5(3):27-32. doi: 10.4322/acr.2015.014. eCollection 2015 Jul-Sep.
Chagas disease (CD) - a tropical parasitic disease caused by the protozoan Trypanosoma cruzi - is a major health problem in Latin America. The immune response against the parasite is responsible for chronic CD lesions. Currently, there are no reports of an association between CD and membranous nephropathy (MN). The detection of the phospholipase A2 receptor (PLA2R) as a target antigen in idiopathic MN can improve the differential diagnosis of primary and secondary forms of MN. The authors report the case of a male patient with positive serology for CD who presented sudden death and underwent autopsy. Histological sections of the heart showed multifocal inflammatory infiltrate composed mainly of mononuclear cells, leading to myocardiocytes necrosis and interstitial fibrosis. The kidneys showed a MN with positive expression for PLA2R. As far as we know, this is the first report of a case of primary MN in a patient with CD, with severe chronic cardiomyopathy and heart failure.
恰加斯病（CD）——一种由原生动物克氏锥虫引起的热带寄生虫病——是拉丁美洲的一个主要健康问题。针对该寄生虫的免疫反应是慢性CD病变的原因。目前，尚无关于CD与膜性肾病（MN）之间关联的报道。在特发性MN中检测磷脂酶A2受体（PLA2R）作为靶抗原可改善MN原发性和继发性形式的鉴别诊断。作者报告了一例血清学检测CD呈阳性的男性患者，该患者突然死亡并接受了尸检。心脏组织切片显示多灶性炎症浸润，主要由单核细胞组成，导致心肌细胞坏死和间质纤维化。肾脏显示为PLA2R表达阳性的MN。据我们所知，这是首例CD患者并发原发性MN、严重慢性心肌病和心力衰竭的病例报告。
