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Abstract: PO1615

Pauci-Immune Crescentic Glomerulonephritis Associated with Pulmonary Coccidioidomycosis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • González, Elvira, Banner University Medical Center Tuscon, Tucson, Arizona, United States
  • Bracamonte, Erika R., Banner University Medical Center Tuscon, Tucson, Arizona, United States
  • Yau, Amy, Banner University Medical Center Tuscon, Tucson, Arizona, United States
Introduction

Coccidioidomycosis is an endemic fungal infection in the southwestern United States There are around 150,000-300,000 cases annually, of which 60% occur in the state of Arizona. Most patients are asymptomatic. 40% have primary pulmonary involvement and present with dyspnea and fatigue. A minority (around 1%) have extrapulmonary dissemination with unknown incidence of renal involvement.

Case Description

We report a 70-year-old immunocompetent patient with CKD (baseline creatinine of 1.2 mg/dL) recent diagnosis of pulmonary coccidioidomycosis presenting with AKI due to ANCA negative pauci-immune crescentic GN. Our patient was referred to nephrology for worsened renal function, creatinine of 1.7 mg/dL. He was diagnosed with pulmonary coccidioidomycosis 3 months prior and started on fluconazole 400 mg daily. Due to concern for disseminated coccidioidomycosis, underwent a renal biopsy showing minimally active pauci-immune crescentic GN (Fig 1). Complement levels were normal, ANCA immunofixation, anti-MPO and anti-PR3 titers were negative. He was initiated on prednisone 60 mg daily with appropriate supportive therapy and gradually tapered over the following three months with partial improvement to his creatinine to 1.5 mg/dL from a peak of 1.9 mg/dL (Fig 2).

Discussion

This is the third known reported case of pauci-immune crescentic GN associated with coccidioidomycosis, and one of a handful of case reports describing pauci-immune crescentic GN in patients with chronic fungal infections. Our case highlights the importance in understanding the pathogenesis and prognosis of chronic fungal infections and GN.