Lathiya Maulik K, Errabelli Praveen, Mignano Salvatore, Cullinan Susan M
Department of Emergency Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, United States.
Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54703, United States.
World J Nephrol. 2023 May 25;12(3):66-72. doi: 10.5527/wjn.v12.i3.66.
Anaplasmosis is a tick-borne disease with a range of clinical manifestations, from a flu-like illness with fever and myalgias to a severe systemic disease with multisystem organ failure. Although renal involvement is not a common presentation, there have been few cases reporting acute kidney injury from Anaplasmosis.
We present a 55-year-old female with anaplasmosis who developed acute kidney injury due to membranoproliferative glomerulonephritis (MPGN). The patient originally presented with cough and shortness of breath. She was admitted to the hospital with a diagnosis of community acquired pneumonia and received antibiotics. During the hospital course she developed severe acute renal failure. Initial serological work up didn't provide any conclusive diagnosis. Hence, she underwent kidney biopsy which showed MPGN pattern suggesting autoimmune, multiple myeloma or infectious etiology. Extensive work up was undertaken which was negative for autoimmune diseases, vasculitis panel, paraproteinemias but tested positive for IgG anaplasma with high titers indicating Anaplasmosis.
Our case shows a unique presentation of severe acute renal failure from MPGN from tick borne illness. MPGN is usually seen with autoimmune diseases, hepatitis C virus infections, paraproteinemias. Hence, we suggest that tick borne illness should also be considered when evaluating acute renal failure cases in tick borne prevalent regions.
无形体病是一种由蜱传播的疾病,临床表现多样,从伴有发热和肌痛的流感样疾病到伴有多系统器官衰竭的严重全身性疾病。虽然肾脏受累并不常见,但已有少数无形体病导致急性肾损伤的病例报道。
我们报告一名55岁患无形体病的女性,因膜增生性肾小球肾炎(MPGN)发生急性肾损伤。患者最初表现为咳嗽和气短。她因社区获得性肺炎入院并接受了抗生素治疗。在住院期间,她发展为严重急性肾衰竭。最初的血清学检查未得出任何确诊结果。因此,她接受了肾活检,结果显示为MPGN模式,提示自身免疫性、多发性骨髓瘤或感染性病因。进行了广泛检查,自身免疫性疾病、血管炎指标、副蛋白血症检查均为阴性,但IgG无形体检测呈高滴度阳性,表明为无形体病。
我们的病例显示了蜱传疾病导致MPGN引发严重急性肾衰竭的独特表现。MPGN通常见于自身免疫性疾病、丙型肝炎病毒感染、副蛋白血症。因此,我们建议在蜱传疾病流行地区评估急性肾衰竭病例时,也应考虑蜱传疾病。