Yamashiro Aoi, Uchida Takahiro, Ito Seigo, Oshima Naoki, Oda Takashi, Kumagai Hiroo
Department of Nephrology and Endocrinology, National Defense Medical College, Japan.
Intern Med. 2016;55(18):2669-72. doi: 10.2169/internalmedicine.55.6885. Epub 2016 Sep 15.
A 46-year-old woman suddenly developed peripheral edema. Her massive proteinuria, hypoproteinemia, and renal biopsy findings yielded the diagnosis of minimal change disease (MCD). In addition, lung Mycobacterium avium infection was diagnosed according to a positive culture of her bronchoalveolar lavage fluid. The lung lesion was improved by anti-nontuberculous mycobacteria therapy. Surprisingly, her proteinuria also gradually decreased and she attained complete remission of MCD without any immunosuppressive therapy. She has subsequently remained in complete remission. We herein report an interesting case of MCD with lung Mycobacterium avium infection, suggesting a causal relationship among infection, immune system abnormality, and MCD/nephrotic syndrome.
一名46岁女性突然出现外周水肿。她的大量蛋白尿、低蛋白血症以及肾活检结果确诊为微小病变病(MCD)。此外,根据支气管肺泡灌洗液培养阳性诊断为肺部鸟分枝杆菌感染。抗非结核分枝杆菌治疗后肺部病变有所改善。令人惊讶的是,她的蛋白尿也逐渐减少,且未接受任何免疫抑制治疗就实现了MCD的完全缓解。随后她一直保持完全缓解状态。我们在此报告一例伴有肺部鸟分枝杆菌感染的MCD有趣病例,提示感染、免疫系统异常与MCD/肾病综合征之间存在因果关系。