Document Detail

Henoch-Schönlein purpura-like presentation in IgA-dominant Staphylococcus infection - associated glomerulonephritis - a diagnostic pitfall.
MedLine Citation:
PMID:  23320971     Owner:  NLM     Status:  MEDLINE    
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.
DESIGN: 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.
CONCLUSION: 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.
Anjali A Satoskar; Matthew Molenda; Patrice Scipio; Rosemary Shim; Matthew Zirwas; Reena S Variath; Sergey V Brodsky; Gyongyi M Nadasdy; Lee Hebert; Brad Rovin; Tibor Nadasdy
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  79     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-29     Completed Date:  2013-06-26     Revised Date:  2013-07-01    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  302-12     Citation Subset:  IM    
Department of Pathology, Ohio State University Medical Center. Columbus, OH, USA.
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MeSH Terms
Adrenal Cortex Hormones / therapeutic use
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use
Diagnostic Errors*
Glomerulonephritis, IGA / diagnosis*,  drug therapy,  microbiology,  pathology
Immunosuppressive Agents / therapeutic use
Kidney Glomerulus / immunology,  pathology*
Methicillin-Resistant Staphylococcus aureus / isolation & purification*
Middle Aged
Predictive Value of Tests
Purpura, Schoenlein-Henoch / diagnosis*,  drug therapy,  pathology
Skin / pathology
Staphylococcal Infections / diagnosis*,  drug therapy,  microbiology,  pathology
Unnecessary Procedures
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Bacterial Agents; 0/Immunosuppressive Agents
Erratum In:
Clin Nephrol. 2013 Jun;79(6):504
Note: Scipio, Patrice [added]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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