title: Henoch-Schönlein purpura-like presentation in IgA-dominant Staphylococcus infection - associated glomerulonephritis - a diagnostic pitfall.
abstract: BACKGROUND
  In children and adults, Henoch-Schönlein purpura (HSP) has a characteristic clinical presentation that includes a purpuric lower extremity skin rash, IgA-dominant glomerulonephritis, and abdominal and joint pain. A similar clinical presentation can be seen in adults who have a systemic infection with methicillin-resistant Staphylococcus aureus. It is critically important to distinguish the IgAdominant glomerulonephritis of HSP from the IgA-dominant glomerulonephritis of staphylococcal infection, because HSP may need to be treated with corticosteroids and immunosuppressives, while Staphylococcus infection-associated glomerulonephritis requires antibiotics.
  
  
  METHODS
  We searched our renal biopsy database for cases of Staphylococcus infection-associated IgA-dominant glomerulonephritis, to identify those with an HSP-like presentation. Their clinical, laboratory, and biopsy findings are reviewed.
  
  
  RESULTS
  Between 2004 and 2011, we identified 37 patients with culture-proven Staphylococcus infection-associated glomerulonephritis. Of these, 8 (22%) had an HSP-like presentation manifested by lower extremity purpuric skin rash. Mesangial IgA and C3 deposits were consistent findings on kidney biopsy. Crescents were uncommon. Four of the 8 patients received glucocorticoid (steroid) therapy for a presumed diagnosis of HSP. Renal function worsened in 3 patients, and 1 patient ultimately improved but developed sepsis during the course. Overall, renal outcome was poor in 71% of the cases despite mild chronic renal injury in the biopsy.
  
  
  CONCLUSIONS
  In adult patients with an HSPlike presentation, a high index of suspicion for underlying Staphylococcal infection is warranted. Blood cultures are frequently negative. Cultures from the site of infection should be performed. Steroid treatment did not improve outcomes. Renal outcomes were frequently poor.
authors: Department of Pathology, Ohio State University Medical Center. Columbus, OH, USA. anjali.satoskar@osumc.edu
authors: Anjali A
authors: AA
authors: Satoskar
authors: Matthew
authors: M
authors: Molenda
authors: Patrice
authors: P
authors: Scipio
authors: Rosemary
authors: R
authors: Shim
authors: Matthew
authors: M
authors: Zirwas
authors: Reena S
authors: RS
authors: Variath
authors: Sergey V
authors: SV
authors: Brodsky
authors: Gyongyi M
authors: GM
authors: Nadasdy
authors: Lee
authors: L
authors: Hebert
authors: Brad
authors: B
authors: Rovin
authors: Tibor
authors: T
authors: Nadasdy
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003951:Diagnostic Errors; D005260:Female; D005922:Glomerulonephritis, IGA / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012867:Skin / Q000473:pathology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D019564:Unnecessary Procedures
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents