IgA Nephropathy Flare-Up Mimicking Staphylococcus Post-Infection Glomerulonephritis in Patient with Staphylococcus Aureus Infection Treated with Cefazolin: A Case Report and Brief Review of the Literature
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction , Rare disease, Clinical situation which can not be reproduced for ethical reasons
Hajar AlQahtani, Fulwah Y. Alqahtani, Fadilah S. Aleanizy, Saeed Baloch, Deanne Tabb
Department of Clinical Pharmacy, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, GA, Saudi Arabia
Am J Case Rep 2019; 20:508-510
Glomerulonephritis (GN) associated with post staphylococcus infection (PSIGN) and high serum immunoglobulin A (IgA) has been reported recently. Patients with GN after infection with underlying IgA nephropathy create a challenge to determine the etiology of GN. Therefore, treatment should be accordingly, with steroids used if the IgA nephropathy flare-up is determined to be the etiology. The aim of this case report was to shed light on the difference between PSIGN and IgA nephropathy flare-ups in patients with a history of IgA nephropathy, and how to treat patient cases accordingly.
CASE REPORT: An 81-year-old male presented to our Emergency Department complaining of increasing pain, swelling, and redness of his left knee since 2 days ago. He had a history of recent methicillin sensitive Staphylococcus aureus (MSSA) left knee arthroplasty infection that was treated with cefazolin, and he had a history of IgA nephropathy diagnosed 1 year ago.
CONCLUSIONS: In our patient case, renal biopsy studies were not enough to differentiate between PSIGN and IgA nephropathy flare-ups, thus, clinical presentation was important. PSIGN was found to have a delayed onset compared to IgA nephropathy. Lower serum complement 3 (C3) level, heavier proteinuria, and acute renal failure are common with PSIGN compared to IgA nephropathy. Identifying the etiology and treating our patient accordingly with immunosuppressive therapy had a positive impact on the patient, restoring renal function without further damage.
Keywords: Glomerulonephritis, IGA, Staphylococcus aureus, Vasculitis