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Abstract: TH-PO528

A Case of Successful Treatment of Collapsing FSGS Secondary to Parvovirus B19

Session Information

  • Trainee Case Reports - I
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sheikh, Fatima, Northwell, New Hyde Park, New York, United States
  • Bijol, Vanesa, Northwell Health Hofstra University, Lake Success, New York, United States
  • Ross, Daniel W., Northwell Health Hofstra University, Lake Success, New York, United States
Introduction

Parvovirus B19 is a rare cause of collapsing glomerulopathy. The clinical course of collapsing glomerulopathy is characterized by proteinuria and progressive renal failure. This case discusses the first immunocompetent patient with biopsy proven collapsing glomerulopathy secondary to Parvovirus B19 successfully treated with Intravenous Immunoglobulin (IVIG).

Case Description

A 38 year old African American man presented to our ED with three days of fatigue, poor appetite, fever, chills, night sweats, and joint pain with swelling. At time of our evaluation his vital signs were within normal limits and physical exam was unremarkable. Laboratory data upon admission was notable for elevated creatinine (1.6mg/dL) and proteinuria (7.2 g/g). The patient’s IgG, IgM and PCR for Parvovirus were positive. Kidney biopsy revealed collapsing glomerulopathy with acute tubular injury and minimal interstitial fibrosis.
The patient’s PCR titer was elevated to 542,000 IU/ml on hospital day 5. Intravenous immunoglobulin (IVIg) was started on day 6 at a dose of 400 mg/kg/day for a total dose of 150 grams over five days. On day 8, his repeat parvovirus PCR began to trend down. The patient’s creatinine peaked at 2.29 mg/dL on hospital day 6 however then it began to trend down with treatment as well. The patient was discharged in stable condition on hospital day 11. Three weeks after discharge all his symptoms had abated and his serum creatinine improved to 1.38 mg/dL with proteinuria of 1.1g/g. Patient’s parvovirus PCR titer notably decreased to 3,400 IU/ml with this treatment.

Discussion

Collapsing glomerulopathy is prevalaent in patients with human immunodeficiency virus (HIV) and more recently, there have been several cases showing an association with Parvovirus B19. Optimal treatment for Parvovirus associated collapsing glomerulopathy is unknown. We were able to diagnose Parvovirus B19 early by elevated viral PCR and initiated treatment for our patient quickly preventing further progressive renal damage. In addition to strict blood pressure control, the patient was treated with IVIG at a dose of 400mg/kg for five days. The patient was not placed on any corticosteriod therapy. The patient’s Parvovirus viral PCR, serum creatinine and proteinuria trended downward. This is the first patient with successful corticosteriod-free treatment of parvovirus induced FSGS with intravenous immunoglobulin.