Henoch-Schonlein purpura, post-streptococcal glomerulonephritis and acute rheumatic carditis after Group A β-haemolytic streptococcal infection.
Besides association with acute rheumatic fever (ARF) and acute glomerulonephritis (APSGN), in up to 40% of cases, Group A β-haemolytic streptococcal (GABHS) infections are also implicated as a trigger for Henoch-Schonlein purpura (HSP). A 7-year-old girl with GABHS throat infection who developed HSP, APSGN and rheumatic carditis is reported. She presented with palpable purpura and arthritis in both ankles and later developed carditis characterised by mitral/aortic regurgitation and glomerulonephritis characterised by mixed nephritic/nephrotic syndrome. She had a raised anti-streptolysin titre (ASOT), blood urea nitrogen and creatinine and hypocomplementaemia (C3), and renal biopsy demonstrated endocapillary and extracapillary proliferative glomerulonephritis with crescents. Immunofluorescence microscopy demonstrated a 'full house' of immunoglobulin and complement, viz. IgA + 2, IgG + 3, IgM + 2, C3c + 1, Clq + 2 with predominantly IgG deposition. One week earlier, her 4-year-old sister had presented to another hospital with HSP complicated by microscopic haematuria, nephrotic-range proteinuria and gastro-intestinal involvement, and with raised ASOT and low C3levels. Although HSP has been associated with either ARF or APSGN, this is the first case of a child with HSP, ARF and APSGN in combination.
a Division of Pediatric Nephrology, Department of Pediatrics , Medical Faculty of Dokuz Eylul University , Izmir , Turkey.
Seçil
S
Arslansoyu Çamlar
a Division of Pediatric Nephrology, Department of Pediatrics , Medical Faculty of Dokuz Eylul University , Izmir , Turkey.
Alper
A
Soylu
b Division of Pediatric Nephrology, Department of Pediatrics , Medical Faculty of Celal Bayar University , Manisa , Turkey.
İpek
İ
Akil
c Department of Pathology , Medical Faculty of Dokuz Eylul University , Izmir , Turkey.
Mehtat
M
Ünlü
d Division of Pediatric Cardiology, Department of Pediatrics , Medical Faculty of Celal Bayar University , Manisa , Turkey.
Şenol
Ş
Coşkun
b Division of Pediatric Nephrology, Department of Pediatrics , Medical Faculty of Celal Bayar University , Manisa , Turkey.
Pelin
P
Ertan
a Division of Pediatric Nephrology, Department of Pediatrics , Medical Faculty of Dokuz Eylul University , Izmir , Turkey.
Salih
S
Kavukçu
D000989:Antistreptolysin / Q000097:blood; D001706:Biopsy; D002648:Child; D003165:Complement System Proteins / Q000032:analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D006651:Histocytochemistry; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D007150:Immunohistochemistry; D007668:Kidney / Q000473:pathology; D008853:Microscopy; D008856:Microscopy, Fluorescence; D012214:Rheumatic Heart Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D013290:Streptococcal Infections / Q000150:complications*; D014508:Urea / Q000097:blood
D014508:Urea; D000989:Antistreptolysin; D003165:Complement System Proteins; D003404:Creatinine
Acute post-streptococcal glomerulonephritis; Group A beta-haemolytic streptococcus; Henoch–Schonlein purpura; acute rheumatic fever