Nair Vinay, Jandovitz Nicholas, Jhaveri Kenar D, Hirschwerk David, Grodstein Elliot, Bijol Vanesa, Molmenti Ernesto, Teperman Lewis
Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Department of Pharmacy, North Shore University Hospital, Northwell Health.
Clin Nephrol Case Stud. 2020 May 29;8:41-45. doi: 10.5414/CNCS110113. eCollection 2020.
Collapsing glomerulopathy (CG) is a severe form of glomerulopathy which results in nephrotic syndrome and often ensues in rapid progression to end-stage kidney disease (ESKD). Although most commonly a result of HIV infection, other conditions such as parvovirus B19 (PB19) infection have been associated with CG. We present a case of an 18-year-old male with CG associated with PB19 infection who was heterozygous for G1 and G2 genetic variants. In an attempt to treat, he was started on intravenous immunoglobulin (IVIg), however rapidly progressed to ESKD. During workup for a living donor kidney transplant he was found to have persistent low-grade PB19 viremia. Despite having no major immunodeficiency and given subsequent courses of IVIg, viremia continued to persist. In a final attempt to eradicate the PB19 we began treatment with cidofovir, an antiviral agent with in vitro efficacy against PB19. Subsequent to initiation of cidofovir, PB19 viremia slowly cleared after which he received a living unrelated kidney transplant. The patient had an early cellular rejection treated with rabbit antithymocyte globulin after which he recovered kidney function without signs of recurrent CG. Our case report suggests efficacy of IVIg and cidofovir for persistent PB19 infection in ESKD to allow subsequent transplantation, while minimizing the risk of recurrent CG.
塌陷性肾小球病（CG）是一种严重的肾小球病形式，可导致肾病综合征，并常常迅速进展为终末期肾病（ESKD）。虽然最常见的是由HIV感染引起，但其他情况如细小病毒B19（PB19）感染也与CG有关。我们报告一例18岁男性CG患者，其与PB19感染相关，该患者G1和G2基因变异为杂合子。为进行治疗，开始给他静脉注射免疫球蛋白（IVIg），然而他迅速进展为ESKD。在对活体供肾移植进行检查期间，发现他持续存在低水平PB19病毒血症。尽管没有严重免疫缺陷且后续给予了IVIg疗程，但病毒血症仍持续存在。在最后一次根除PB19的尝试中，我们开始用西多福韦治疗，西多福韦是一种体外对PB19有效的抗病毒药物。开始使用西多福韦后，PB19病毒血症逐渐清除，之后他接受了非亲属活体肾移植。患者出现早期细胞性排斥反应，用兔抗胸腺细胞球蛋白治疗后肾功能恢复，无CG复发迹象。我们的病例报告表明，IVIg和西多福韦对ESKD中持续的PB19感染有效，可允许后续移植，同时将CG复发风险降至最低。
