Infection-Related Glomerulonephritis (IRGN) due to Gordonia Bacteremia in an Immunocompetent Patient with a Femoral Catheter
- Glomerular Diseases: From Inflammation to Fibrosis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1401 Glomerular Diseases: From Inflammation to Fibrosis
- Aydin-Ghormoz, Emmanuel Albert, Albany Medical College, Albany, New York, United States
- Lightle, Andrea R., Albany Medical College, Albany, New York, United States
- Monrroy, Mauricio, Albany Medical College, Albany, New York, United States
Gordonia species rarely cause human infection, though cases of bacteremia in immunocompromised patients with endovascular devices have been reported. These may be under-recognized as blood cultures (BC) can be negative until 4 or more days after incubation. We report a case of IRGN secondary to Gordonia bacteremia in an immunocompetent patient with a chronic femoral catheter.
A 61-year-old woman with complex regional pain syndrome on buprenorphine infusion via femoral catheter presented to our hospital with AKI on outpatient labs. She had been hospitalized 1 year prior with a diffuse macular rash while on Bactrim for cellulitis. At that time, she was febrile with negative BC and low C3/C4. Skin biopsy showed leukocytoclastic vasculitis (LCV), presumed to be drug-induced. Rash resolved with broad-spectrum antibiotics (Abx). At the current presentation, creatinine was 5.37mg/dL. UA showed 1+ protein and innumerable RBCs. C3 was low and rheumatoid factor (RF) was elevated. Renal biopsy showed diffuse proliferative crescentic immune-complex GN with full house staining pattern suspicious for lupus nephritis, though all serologies (except RF) returned negative. She developed fever after routine femoral catheter exchange and BC were sent. Steroid therapy was started for suspected autoimmune GN when BC were negative for 2 days. Unfortunately, after a sneezing spell she developed a spontaneous left subdural hematoma (SDH) with active bleeding requiring craniotomy. By then, BC (2 sets) grew Gordonia polyisoprenivorans at 3 days. Abx were started. Steroids were stopped. She briefly required hemodialysis but had rapid renal recovery with Abx. Unfortunately, she had further intracranial complications including transtentorial herniation and persistent comatose state. Family elected to continue all care. She was discharged to a nursing facility.
The patient’s AKI and biopsy findings were attributed to IRGN. There was suspicion her spontaneous SDH was secondary to vascular mycotic infection from Gordonia bacteremia, and prior LCV may have been a manifestation of chronic bacteremia. Clinicians should have a high index of suspicion for slow-growing bacterial infections as an etiology of IRGN in unexplained glomerular disease, especially in patients with indwelling central catheters.