[1695] Staphyloccal Infection Associated Glomerulonephritis Mimicking Henoch-Schönlein Purpura

Anjali A Satoskar, Rosemary Shim, Sergey Brodsky, Gyongyi Nadasdy, Lee Hebert, Tibor Nadasdy. Ohio State University Medical Center, Columbus, OH

Background: A patient with IgA dominant immune complex glomerulonephritis (GN) who presented with joint pain, petechial and bullous skin rash, and renal failure was treated with steroids and became septic. This prompted us to review our kidney biopsy material for Staphylococcus infection associated GN cases presenting clinically like HSP. Petechial rash has been described in patients with Stahylococcal infection related GN, but in the absence of known history of infection, this can be a diagnostic pitfall.
Design: We found 33 kidney biopsies from patients with culture proven Staphylococcus infection associated GN in our biopsy archives from 2005 to 2010. Seven of these had petechial skin rash.
Results:

Table 1

Patient	Diabetes	Infection	Organism	Blood culture	Creatinine at biopsy	Creatinine at follow up	C3 ; C4
1	present	leg ulcers, osteomyelitis	MRSA	Negative	9.7	dialysis	69 ; 30
2	present	leg ulcers	MRSA	Negative	4.5	dialysis	not known
3	absent	groin abscess	MSSA	Negative	4.6	dialysis	11 ; normal
4	absent	endocarditis	MRSA	Positive	2	2	104 ; 18
5	absent	skin wounds; motor vehicle accident	MRSA	Negative	1.9	dialysis	163 ; 25
6	absent	osteomyelitis	MSSA	Negative	2.8	1.3 improved	144 ; 24
7	absent	Abdominal wall abscess	MRSE	Positive	2.3	dialysis	169 ; 43

MRSE = methicillin resistant Staphylococcus epidermidis, MSSA=Methicillin sensitive Staphylococcus aureus

Patients ranged from 51 to 90 years of age. Acute renal failure, hematuria and proteinuria was the mode of presentation. Low complement levels were seen in only 2/7 patients. In 4 patients,infection was diagnosed only around the time of renal biopsy. In 3 patients, history of infection was known a few weeks before the biopsy. Followup period ranged from 1 to 8 months. Glomerular intracapillary proliferation, mild interstitial inflammation and red blood cell casts were the most common morphologic findings. Small crescents were seen in 2/7 biopsies. Interstitial fibrosis was prominent in 3/7 biopsies. Mesangial IgA and C3 were constant findings. Subepithelial humps were seen in two biopsies.
Conclusions: Staphylococcal infection associated IgA dominant glomerulonephritis can present with skin rash and therefore mimic HSP. A high index of suspicion for underlying Staphylococcal infection is warranted in adult patients with HSP-like presentation. Immunosuppressive treatment in such patients can induce sepsis. Blood cultures are frequently negative. Cultures from the site of infection are recommended. Renal outcome can be unpredictable.
Category: Kidney (does not include tumors)

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 285, Wednesday Afternoon