Abstract: PO0306
Candida parapsilosis Endocarditis Presenting as Acute Glomerulonephritis: A Case Report
Session Information
- AKI: Clinical Case Reports
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
Authors
- Truong, Tai, Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
- Lee, Devin, Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
- Sedlacek, Martin, Dartmouth-Hitchcock Health GraniteOne, Lebanon, New Hampshire, United States
Introduction
Candida species is an uncommon cause of left sided endocarditis that traditionally associated with high morbidity rate. In a few rare cases, Candida endocarditis has been reported as a cause of infection related GN. Here, we described a case of Candida parapsilosis endocarditis that presented as acute glomerulonephritis.
Case Description
A 52 y.o Caucasian female with history of antiphospholipid syndrome, intravenous drug use history on suboxone who presented with 3 weeks of dyspnea, LE edema and tea colored urine. She was found to have elevation in creatinine to 3.6mg/dL from baseline of 1.08mg/dL. There was no history of fever, chill, night sweats, weight loss. There was a dime sized healing ulcer on the thigh. Due to her high risk thrombotic history, she received heparin for anticoagulation. A urine dipstick showed >300 protein and 3+ blood. A spot urine protein to creatinine ratio was 4.5. The urine sediment showed granular and hyaline casts, many RBC of normal morphology and rare acanthocytes. The C3 level was mildly decreased at 60 and C4 level normal at 14. She had mildly elevated ANA at 1:80 and negative double strand DNA, smooth muscle antibody level, PR3/MPO and extractable nuclear antigen antibody including SSA/SSB, RnP, Scl-70 and Jo-1 antibody level. A CRP was 33 and ESR was 47. Blood cultures revealed Candida parapsilosis. MRI spine with inflammatory changes of L4-L5 suggesting osteomyelitis. Patient received micafungin but remained persistently fungemic. A TEE revealed a large mitral valve vegetation. While under evaluation for mitral valve surgery, she suffered from a large right MCA stroke and deceased within 48 hours from brain herniation. No autopsy performed due to family’s request.
Discussion
Fungal associated GN is a rare clinical entity that usually mentioned only as a foot note in textbooks. The mechanism of kidney injury is likely immune complex deposition. Given the high mortality rate with Candida endocarditis and its associated complications, heightened clinical suspicion and early aggressive treatment with antifungal and surgery are important. Corticosteroid in one case report improved renal function indicating a possible role in patients with controlled infection.