Gavcovich Tara, Al Barbandi Malek, Millan Pamela, Isner Elizabeth, Defreitas Marissa J, Glaberson Wendy, Katsoufis Chryso P, Chandar Jayanthi, Sigurjonsdottir Vaka, Gonzalez Ivan A, Swaminathan Sethuraman, Zuo Yiqin, Abitbol Carolyn L, Seeherunvong Wacharee
Department of Pediatrics, Holtz Children's Hospital, Miami, FL, United States.
Division of Pediatric Nephrology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.
Front Pediatr. 2023 Jan 16;10:1093300. doi: 10.3389/fped.2022.1093300. eCollection 2022.
Infective endocarditis (IE) can cause multiorgan dysfunction and chronic kidney disease, in addition to cardiac sequelae. The presentation may be vague and can manifest as acute glomerulonephritis. While the most common pathogens of infective endocarditis are and species, we report a rare pathogen causing infective endocarditis associated glomerulonephritis. A 20-year-old male patient with tetralogy of Fallot with pulmonary atresia and aortopulmonary collaterals underwent several cardiac surgeries including prosthetic pulmonary valve replacement in the past. He was admitted for 3 days at an outside hospital for fever, cough, and hemoptysis, and diagnosed with streptococcal pharyngitis, for which he received antibiotics. Five weeks later, he presented to our institution with lower extremity edema and gross hematuria. On examination, he was afebrile, normotensive, had a 7-kg weight gain with anasarca, and a systolic murmur, without rash. Investigations revealed elevated serum creatinine, nephrotic range proteinuria, hematuria, and hypocomplementemia, consistent with acute glomerulonephritis. Given his cardiac history, blood cultures were collected from three sites. Broad-spectrum antibiotics were initiated when he subsequently developed fever. Renal pathology on biopsy showed diffuse proliferative immune complex-mediated glomerulonephritis. Transesophageal echocardiogram visualized a vegetation on the pulmonary valve. was ultimately cultured from the prior and current hospitalization. A serum sample detecting microbial cell-free DNA sequencing confirmed at very high levels. After completing 6 weeks of intravenous antibiotics with concurrent angiotensin receptor blockade, his kidney function recovered with improvement in hypocomplementemia and proteinuria. This case report highlights the early recognition and comprehensive evaluation of a rare organism causing IE-associated GN, which allowed for renal recovery and preserved cardiac function.
感染性心内膜炎（IE）除了会导致心脏后遗症外，还可引起多器官功能障碍和慢性肾脏病。其临床表现可能不典型，可表现为急性肾小球肾炎。虽然感染性心内膜炎最常见的病原体是 和 菌属，但我们报告了一种罕见的病原体 导致感染性心内膜炎相关的肾小球肾炎。一名20岁男性患者，患有法洛四联症合并肺动脉闭锁及主肺动脉侧支循环，过去曾接受多次心脏手术，包括人工肺动脉瓣置换术。他因发热、咳嗽和咯血在外院住院3天，被诊断为链球菌性咽炎，并接受了抗生素治疗。五周后，他因下肢水肿和肉眼血尿前来我院就诊。检查发现，他体温正常，血压正常，因全身水肿体重增加7公斤，有收缩期杂音，无皮疹。检查发现血清肌酐升高、肾病范围蛋白尿、血尿和补体降低，符合急性肾小球肾炎。鉴于他的心脏病史，从三个部位采集了血培养样本。随后他发热时开始使用广谱抗生素。肾活检病理显示为弥漫性增生性免疫复合物介导的肾小球肾炎。经食管超声心动图显示肺动脉瓣上有赘生物。最终从之前和此次住院期间的血培养中培养出 。一份检测微生物游离DNA测序的血清样本证实 水平非常高。在完成6周的静脉抗生素治疗并同时使用血管紧张素受体阻滞剂后，他的肾功能恢复，补体降低和蛋白尿情况有所改善。本病例报告强调了对导致IE相关GN的罕见病原体的早期识别和综合评估，这使得肾功能得以恢复并保留了心脏功能。
