Cacciapuoti Martina, Mazzitelli Maria, Naso Elena, De Giorgi Maria Loreta, Samassa Giovanni, Di Vico Valentina, Marinello Serena, Stefanelli Lucia Federica, Calò Lorenzo, Cattelan Annamaria, Nalesso Federico
Nephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, Italy.
Infectious and Tropical Disease Unit, University Hospital of Padova, 35128 Padova, Italy.
Microorganisms. 2025 Apr 29;13(5):1019. doi: 10.3390/microorganisms13051019.
infections are becoming increasingly frequent in patients with a history of cardiac surgery. We herein report a case of a patient admitted to the Nephrology Unit of Padua University Hospital with deteriorating kidney function, pancytopenia, hypercalcemia, and respiratory symptoms that emerged seven years after they underwent heart surgery for prosthetic aortic valve replacement. A kidney biopsy revealed non-caseating necrotizing granulomatous interstitial nephritis, which was initially diagnosed as idiopathic granulomatous interstitial nephritis. The patient was treated with intravenous corticosteroids since no active infections, including mycobacterial infections, were detected. The negativity of the molecular test following the kidney biopsy delayed the diagnosis of a disseminated infection with endocarditis, myositis, cerebral, and kidney involvement, as blood cultures were available only after six weeks. The patient was started on antimicrobial therapy with azithromycin, moxifloxacin, rifampicin, and ethambutol while prednisone was tapered down, leading to an improvement in kidney function, blood count, and blood calcium level. Our case suggests that a infection should be considered for patients with a history of cardiac surgery and granulomatous interstitial nephritis even in the absence of mycobacteria in a kidney biopsy.
心脏手术史患者的感染越来越频繁。我们在此报告一例帕多瓦大学医院肾病科收治的患者，该患者在接受人工主动脉瓣置换心脏手术后七年出现肾功能恶化、全血细胞减少、高钙血症和呼吸道症状。肾活检显示非干酪样坏死性肉芽肿性间质性肾炎，最初被诊断为特发性肉芽肿性间质性肾炎。由于未检测到包括分枝杆菌感染在内的活动性感染，该患者接受了静脉注射皮质类固醇治疗。肾活检后分子检测呈阴性，延迟了对合并心内膜炎、肌炎、脑和肾受累的播散性感染的诊断，因为六周后才获得血培养结果。在逐渐减少泼尼松用量的同时，患者开始使用阿奇霉素、莫西沙星、利福平和乙胺丁醇进行抗菌治疗，肾功能、血细胞计数和血钙水平有所改善。我们的病例表明，即使肾活检中未发现分枝杆菌，有心脏手术史和肉芽肿性间质性肾炎的患者也应考虑感染的可能。
