Abstract: TH-PO0836
A Rare Case of Minimal Change Disease Associated with Prior Parvovirus B19 Infection
Session Information
- Glomerular Case Reports: Potpourri
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Ames, Juliana E, The University of Kansas School of Medicine, Kansas City, Kansas, United States
- Liang, Kelly V., The University of Kansas Medical Center, Kansas City, Kansas, United States
- Zatreh, Mallak, The University of Kansas Medical Center, Kansas City, Kansas, United States
- Fields, Timothy A., The University of Kansas Medical Center, Kansas City, Kansas, United States
- Mustafa, Reem Adel, The University of Kansas Medical Center, Kansas City, Kansas, United States
Introduction
Nephrotic syndrome (NS) is characterized by proteinuria >3.5 g/24 h, hypoalbuminemia, and edema. Differential diagnosis of NS includes membranous nephropathy (MN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS). We present a case of NS due to MCD in the setting of prior parvovirus B19 (PVB19) infection.
Case Description
A 66-year-old man with history of pancytopenia s/p bone marrow (BM) biopsy, atrial fibrillation s/p ablation, and right upper lobe lung mass presented with weight gain and lower extremity edema. He was a school bus driver and had no smoking history. Physical exam showed 3+ pitting lower extremity edema and bibasilar crackles. CBC showed pancytopenia. BM biopsy before admission showed normohypocellular marrow with 3% blasts and mild dysplasia. Rare (1-2) vacuoles were seen within a minority of myeloid and erythroid precursors, raising concern for VEXAS. Urinalysis had 3+ protein, and urine protein/creatinine ratio (UPCR) was 4.9. Autoimmune workup revealed +ANA 1:160; negative anti-dsDNA, anti-Smith, anti-PLA2R, anti-GBM antibodies (Ab); negative RF, HIV, and hepatitis. C3 was slightly elevated; C4 was normal. Full-body MRA showed no vasculitis. PVB19 PCR was negative, but serology showed IgG+ with negative IgM. Heavy metals were negative. Renal biopsy revealed normal glomeruli on light microscopy but severe podocyte foot process effacement on electron microscopy, consistent with MCD. UBA1 genetic test for VEXAS was negative. He improved with high-dose steroids, tacrolimus, diuretics, and dapsone.
Discussion
This is a rare case of NS due to MCD in an adult. MCD typically occurs in children and is responsive to steroids. PVB19 has been associated with FSGS, proliferative glomerulonephritis, and rarely MCD. It has been associated with aplastic anemia and pancytopenia. Clinical suspicion for PVB19 was higher in this case due to pancytopenia and his job as a school bus driver, with possible exposure through young children. Although PVB19 IgG without IgM Ab makes it less likely that he had acute infection, a prior infection may have triggered an autoimmune response and MCD, which is caused by anti-nephrin Ab in a subset of cases. This case highlights the importance of extensive workup for nephrotic syndrome in adults, the essential role of kidney biopsy, and the link between PVB19 and MCD.