Mycoplasma Associated Minimal Change Disease in a Young Adult; A Case Report
Speaker Credentials
MD
Format
Poster
Start Date
6-11-2020 1:15 PM
End Date
6-11-2020 1:30 PM
Abstract
introduction: Mycoplasma pneumoniae is a leading cause of pneumonia in young adults. Extrapulmonary manifestations include neurologic, hematologic, cardiologic, musculoskeletal, and mucocutaneous, but renal involvement is rare. Minimal change disease is a rare disorder in adults and is usually idiopathic. Additionally, mycoplasma is a rare cause of secondary minimal change disease. Case Description: 28-year-old male presented with lower extremity swelling and progressive exertional SOB for 1 week. He denies fever but reports sore throat and cough four weeks prior. On presentation, vital signs were stable. Exam showed decreased breath sounds and anasarca. Pertinent labs showed AKI and marked hypoalbuminemia. CT scan showed extensive anasarca. A 24hour urinary protein was positive for 6gm/dl of proteinuria. His anasarca and kidney function continued to worsen, therefore a renal biopsy was performed and pulse steroids was started. Biopsy showed podocyte foot process effacement and C3 deposits on immunofluorescence suggesting a diagnosis of minimal change disease and immune-mediated glomerulonephritis. IgM for mycoplasma pneumoniae was positive. In addition to steroids, he received doxycycline, atorvastatin and albumin. His clinical status and kidney function improved and was discharged home in stable condition. Discussion: The association between mycoplasma pneumoniae and renal failure was first reported by Duman in 1976. The antibody and immune complex mediated mechanisms are likely the cause of frank nephrotic syndrome in these patients. Without appropriate intervention there is a high risk of worsening outcomes. Early glucocorticoids remain an appropriate therapy and the dose intensity depends on the clinical and/or histopathological findings. Early treatment of mycoplasma can prevent progression.
Mycoplasma Associated Minimal Change Disease in a Young Adult; A Case Report
introduction: Mycoplasma pneumoniae is a leading cause of pneumonia in young adults. Extrapulmonary manifestations include neurologic, hematologic, cardiologic, musculoskeletal, and mucocutaneous, but renal involvement is rare. Minimal change disease is a rare disorder in adults and is usually idiopathic. Additionally, mycoplasma is a rare cause of secondary minimal change disease. Case Description: 28-year-old male presented with lower extremity swelling and progressive exertional SOB for 1 week. He denies fever but reports sore throat and cough four weeks prior. On presentation, vital signs were stable. Exam showed decreased breath sounds and anasarca. Pertinent labs showed AKI and marked hypoalbuminemia. CT scan showed extensive anasarca. A 24hour urinary protein was positive for 6gm/dl of proteinuria. His anasarca and kidney function continued to worsen, therefore a renal biopsy was performed and pulse steroids was started. Biopsy showed podocyte foot process effacement and C3 deposits on immunofluorescence suggesting a diagnosis of minimal change disease and immune-mediated glomerulonephritis. IgM for mycoplasma pneumoniae was positive. In addition to steroids, he received doxycycline, atorvastatin and albumin. His clinical status and kidney function improved and was discharged home in stable condition. Discussion: The association between mycoplasma pneumoniae and renal failure was first reported by Duman in 1976. The antibody and immune complex mediated mechanisms are likely the cause of frank nephrotic syndrome in these patients. Without appropriate intervention there is a high risk of worsening outcomes. Early glucocorticoids remain an appropriate therapy and the dose intensity depends on the clinical and/or histopathological findings. Early treatment of mycoplasma can prevent progression.