Mesangial Proliferative Glomerulonephritis and Neurocysticercosis: A Novel Association
- Glomerular Diseases: From Inflammation to Fibrosis - II
November 03, 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
- Liao, Jinlan, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Smyth, Brendan, The George Institute for Global Health, Newtown, New South Wales, Australia
The etiology of nephrotic syndrome is diverse, and parasitic infections typically do not cause this condition. Here, we present a case of nephrotic syndrome associated with parasitic infections.
A 21-year-old man with a habit of eating raw fish presented with a 6-week history of bilateral limb edema, back pain and nausea. Nephrotic syndrome with acute kidney injury was diagnosed after finding a creatinine of 163 umol/L, albumin of 19.7 g/L, and proteinuria (9.4 g/day). Peripheral blood eosinophilia was noted (5.78 x109 cells/L). A renal biopsy revealed mesangial-proliferative glomerulonephritis and eosinophils within the renal interstitium. Serum was strongly positive for anti-Taenia solium antibodies (by enzyme linked immunosorbent assay). Cranial magnetic resonance imaging revealed a 9.8 x 12.8mm mass in the fourth ventricle. A specimen of cerebrospinal fluid was also weakly positive for anti-Taenia solium antibodies. On the basis of these findings, a diagnosis of neurocysticercosis was made. The patient did not consent to surgical exploration and removal of cyst in the fourth ventricle. Medical therapy was commenced with albendazole and glucocorticoids. Two months later, 24-hour urinary protein excretion had reduced to 0.8 g/day, and the blood eosinophil level was normal. At a follow-up visit 1 year later, the patient’s renal recovery was found to be complete. MRI of the brain revealed no change in the fourth ventricular cyst and he remained asymptomatic.
This is the first reported case of mesangial-proliferative glomerulonephritis with eosinophilic infiltrate associated with cysticercosis. We hypothesize that this patient’s infection resulted from cross-contamination in the preparation of raw seafood. Cysticercosis should be considered in the differential diagnosis of nephrotic syndrome in areas where Taenia solium is endemic.
Figure 1: Image a is from a renal biopsy, the arrow indicates eosinophils. Image b is from cranial MRI revealed a mass in the fourth ventricle.