Bacterial endocarditis associated with crescentic glomerulonephritis in a kidney transplant patient: first case report.
BACKGROUND
Endocarditis-induced crescentic glomerulonephritis is a well-described complication in nontransplant patients. Its occurrence in transplant patients has not been reported to date.


METHODS
A 50-year-old man who had received a renal allograft 13 years before and been treated with prednisone, 10 mg/day, was admitted for progressive renal failure, purpura, edema of the lower limbs, and fever.


RESULTS
Blood cultures isolated Streptococcus bovis and cardiac ultrasound examination revealed a 23-mm-large vegetation on the mitral valve. His plasma creatinine level was 478 micromol/L and his proteinuria was 5.5 g/day. A renal biopsy showed diffuse crescentic glomerulonephritis. Long-term antibiotic treatment and three methylprednisolone pulses were effective in treating the endocarditis and glomerulonephritis.


CONCLUSIONS
Endocarditis-induced glomerulonephritis is an immune-mediated disease that can also occur on a renal allograft. It is likely that a low daily dose of immunosuppressive treatment may have been a facilitating factor.
Ades
L
L
Service de Néphrologie A and Laboratoire d'Anatomie Pathologique, Hôpital Tenon, Paris, France.
Akposso
K
K
Costa de Beauregard
M A
MA
Haymann
J P
JP
Mougenot
B
B
Rondeau
E
E
Sraer
J D
JD
D003404:Creatinine / Q000097:blood; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000382:microbiology; D005921:Glomerulonephritis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000150:complications* / Q000382:microbiology; D016985:Streptococcus bovis / Q000302:isolation & purification
D007166:Immunosuppressive Agents; D003404:Creatinine; D011241:Prednisone