Yoshida K, Matsubara H, Shibatani N, Tamura A, Umeda Y, Nishiue N, Nagata T, Mori Y, Masaki H, Murasawa S, Iwasaka T, Inada M
Department of Medicine II, Kansai Medical University, Osaka, Japan.
Nihon Jinzo Gakkai Shi. 1998 Jul;40(5):359-63.
A 61-year-old male was referred to our hospital for rapidly progressive azotemia. He was also found to have huge vegetation at the aortic valve causing regurgitation. Biochemical examinations revealed the presence of an immunocomplex associated with decreased circulating complements. In biopsy samples from the kidney, we found the presence of fibrillar crescents, proliferation of mesangial cells, increase in extracellular matrix proteins, atrophy of tubules, infiltration of mononuclear cells in the interstitial regions, high density deposits in the mesangial area and mesangial interposition. Since the patient strongly rejected operative treatment by valvular replacement, we continued non-invasive treatment such as hemodialysis and treatment with penicillin G. This transiently improved the condition of the patient, including biochemical data and cardiac function, but there was no reduction in the size of vegetation at the aortic valve and the bacteria responsible for infective endocarditis were not identified. About three months after admission, overt signs of congestive heart failure emerged and the patients was subjected to intensive care with a respirator and hemodynamic monitoring. Although the cardiac function was improved, concomitant severe pneumonia occurred and the patient died of septic shock. Thus, we report a rare case in whom immune complex-mediated glomerulonephritis was associated with infective endocarditis with aortic valve vegetation.
一名61岁男性因快速进展的氮质血症被转诊至我院。还发现他的主动脉瓣有巨大赘生物，导致反流。生化检查显示存在与循环补体减少相关的免疫复合物。在肾脏活检样本中，我们发现存在纤维状新月体、系膜细胞增殖、细胞外基质蛋白增加、肾小管萎缩、间质区域单核细胞浸润、系膜区高密度沉积物和系膜插入。由于患者强烈拒绝瓣膜置换手术治疗，我们继续进行血液透析和青霉素G治疗等非侵入性治疗。这暂时改善了患者的状况，包括生化数据和心脏功能，但主动脉瓣赘生物的大小没有减小，且未鉴定出导致感染性心内膜炎的细菌。入院约三个月后，出现明显的充血性心力衰竭体征，患者接受了呼吸机和血流动力学监测的重症监护。尽管心脏功能有所改善，但并发了严重肺炎，患者死于感染性休克。因此，我们报告了一例罕见病例，其中免疫复合物介导的肾小球肾炎与伴有主动脉瓣赘生物的感染性心内膜炎相关。
