Mixed cryoglobulinemia and secondary membranoproliferative glomerulonephritis associated with ehrlichiosis

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• 作者：Dawn J. Caster (1)
  James T. Summersgill (1)
  Paisit Paueksakon (2)
  Robert F. Massung (3)
  Wun-Ju Shieh (4)
  Kenneth R. McLeish (1) (5)
  
• 关键词：Membranoproliferative glomerulonephritis ; Nephrotic syndrome ; Ehrlichiosis ; Infection ; Cryoglobulinemia
• 刊名：CEN Case Reports
• 出版年：2014
• 出版时间：November 2014
• 年：2014
• 卷：3
• 期：2
• 页码：178-182
• 全文大小：829 KB
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• 作者单位：Dawn J. Caster (1)
  James T. Summersgill (1)
  Paisit Paueksakon (2)
  Robert F. Massung (3)
  Wun-Ju Shieh (4)
  Kenneth R. McLeish (1) (5)
  
  1. Department of Medicine, University of Louisville School of Medicine, 570 South Preston Street 鈥?102 South, Donald Baxter Research Bldg, Louisville, KY, 40202, USA
  2. Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
  3. Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
  4. Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
  5. Robley Rex VAMC, Louisville, KY, USA
  
• ISSN：2192-4449

文摘

Ehrlichiosis is a tick-borne disease with diverse clinical presentations, ranging in severity from a flu-like illness with fever and myalgias to a serious systemic disease with multisystem organ failure. Nephrotic syndrome has been reported previously in two cases of human ehrlichiosis. A kidney biopsy revealed minimal change disease in one of those patients. Herein, we present the case of a 40-year-old man with ehrlichiosis who developed nephrotic syndrome, cryoglobulinemia, and secondary membranoproliferative glomerulonephritis (MPGN). The patient originally presented with shortness of breath, diffuse myalgias, headache, and lower extremity edema. He subsequently developed acute kidney injury and underwent kidney biopsy which showed MPGN and acute tubular injury. A tick-borne disease panel was positive for IgM and IgG to Ehrlichia chaffeensis. Serum testing revealed type 3 mixed cryoglobulinemia with no evidence of hepatitis C infection. The cryoprecipitate contained IgM and IgG antibodies to E. chaffeensis. Cryoglobulinemia is frequently associated with infections, particularly hepatitis C; however, our case is the first to describe ehrlichiosis associated with cryoglobulinemia and secondary MPGN.