莱姆病合并IgA肾病1例
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摘要
患者女,49岁,昆虫叮咬后左颈部淋巴结肿大10 d,游走性红斑伴发热6 d。皮肤科情况:双侧颈部、腹股沟可触及多发肿大淋巴结,躯干、四肢多发环形红斑,直径1～4 cm不等。皮损组织病理示:真皮浅层水肿,血管周围灶状淋巴细胞浸润,散在嗜酸性粒细胞及浆细胞。莱姆病螺旋体IgG抗体1∶80,IgM抗体1∶200。予头孢曲松钠输液治疗10 d后皮疹消退。入院2周后尿中泡沫大量增多,24 h尿蛋白7.11 g/d。肾穿活检:局灶系膜增生,伴新月体形成。免疫荧光示:系膜区弥漫IgA、C_3颗粒状沉积。诊断:莱姆病合并IgA肾病。
A 40-year-old female presented with left cervical lymphadenopathy for 10 days,and fever with erythema migrans for 6 days after bitten by an insect. Physical examination showed bilateral cervical and inguinal lymphadenopathy,erythema migrans with the diameter of 1～4 cm on her trunk and limbs. Biopsy of the lesion showed lymphocytes infiltration in upper dermis with scattered eosinophils and plasma cells. IgG and IgM antibodies to Borrelia burgdorferi were 1∶80 and 1∶200 respectively. The lesions faded away after 10 days of intravenous ceftriaxone sodium treatment. On the 14~(th) day of admission,the foam in urine increased dramatically.The 24 h urine protein was 7.11 g/d.Renal biopsy showed focal mesangial proliferation with crescent. Immunofluorescence study showed diffuse granular deposits of IgA and C_3 in the mesangium. The diagnosis of Lyme disease with IgA nephropathy was made.
A 40-year-old female presented with left cervical lymphadenopathy for 10 days,and fever with erythema migrans for 6 days after bitten by an insect. Physical examination showed bilateral cervical and inguinal lymphadenopathy,erythema migrans with the diameter of 1～4 cm on her trunk and limbs. Biopsy of the lesion showed lymphocytes infiltration in upper dermis with scattered eosinophils and plasma cells. IgG and IgM antibodies to Borrelia burgdorferi were 1∶80 and 1∶200 respectively. The lesions faded away after 10 days of intravenous ceftriaxone sodium treatment. On the 14~(th) day of admission,the foam in urine increased dramatically.The 24 h urine protein was 7.11 g/d.Renal biopsy showed focal mesangial proliferation with crescent. Immunofluorescence study showed diffuse granular deposits of IgA and C_3 in the mesangium. The diagnosis of Lyme disease with IgA nephropathy was made.
引文
[1] 张哲夫,万康林,张金声,等.我国莱姆病的流行病学和病原学研究[J].中华流行病学杂志,1997,18(1):8-11.
[2] 谭毓绘,孙荷,刘涌,等.莱姆病诊断技术应用探讨[J].中国临床神经科学,2005,13(3):269-272.
[3] Rolla D,Conti N,Ansaldo F,et al.Post-infectious glomerulonephritis presenting as acute renal failure in a patient with Lyme disease[J].J Renal Inj Prev,2014,3(1):17-20.
[4] Mc Causland FR,Niedermaier S,Bijol V,et al.Lyme disease-associated glomerulonephritis[J].Nephrol Dial Transplant,2011,26(9):3054-3056.
[2] 谭毓绘,孙荷,刘涌,等.莱姆病诊断技术应用探讨[J].中国临床神经科学,2005,13(3):269-272.
[3] Rolla D,Conti N,Ansaldo F,et al.Post-infectious glomerulonephritis presenting as acute renal failure in a patient with Lyme disease[J].J Renal Inj Prev,2014,3(1):17-20.
[4] Mc Causland FR,Niedermaier S,Bijol V,et al.Lyme disease-associated glomerulonephritis[J].Nephrol Dial Transplant,2011,26(9):3054-3056.