Successful treatment of post-MRSA infection glomerulonephritis with steroid therapy.
A 48-year-old man without underlying disease developed mediastinitis and was treated by mediastinal drainage. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the abscess material. He was treated with anti-MRSA antibiotics and the MRSA infection improved. Four weeks after the onset of MRSA infection, he developed rapidly progressive glomerulonephritis (RPGN) with nephrotic syndrome (NS). A renal biopsy showed endocapillary proliferative glomerulonephritis with IgA-predominant glomerular deposition. These clinicopathological findings were consistent with those in glomerulonephritis following MRSA infection (post-MRSA infection glomerulonephritis). The level of serum creatinine increased to 6.3 mg/dl, 7 weeks after the onset of RPGN. At that time, the eradication of MRSA infection was considered. He was given middle-dose steroid therapy. Thereafter, his RPGN with NS improved. MRSA infection did not recur. If the disease activity of post-MRSA infection glomerulonephritis persists after the disappearance of MRSA infection, the application of immunosuppressive therapy with steroids may be useful.
Okuyama
S
S
Department of Internal Medicine, Yuri Kumiai General Hospital, Akita, Japan.
Wakui
H
H
Maki
N
N
Kuroki
J
J
Nishinari
T
T
Asakura
K
K
Komatsuda
A
A
Sawada
K
K
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D004359:Drug Therapy, Combination; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011239:Prednisolone / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013777:Tetrazoles / Q000627:therapeutic use*
D047228:Angiotensin II Type 1 Receptor Blockers; D000900:Anti-Bacterial Agents; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan; D011239:Prednisolone