Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy

Mayra Ortega-Díaz; Marta Puerta Carretero; Juan A Martín Navarro; Teresa Aramendi Sánchez; Roberto Alcázar Arroyo; Elena Corchete Prats; Patricia de Sequera Ortiz; Marta Albalate Ramón; M Teresa Jaldo Rodríguez; Laura Medina Zahonero

doi:10.1016/j.nefro.2019.04.007

Immunosuppression as a trigger for hyperinflammatory syndrome due to Strongyloides stercolaris in membranous nephropathy

Nefrologia (Engl Ed). 2020 May-Jun;40(3):345-350. doi: 10.1016/j.nefro.2019.04.007. Epub 2019 Jul 24.

[Article in English, Spanish]

Affiliations

¹ Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España.
² Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España. Electronic address: [email protected].
³ Servicio de Anatomía Patológica Hospital Universitario Infanta Leonor, Madrid, España.

PMID: 31351697
DOI: 10.1016/j.nefro.2019.04.007

Abstract

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris (S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolaris in a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.

Keywords: Acute kidney disease; Fracaso renal agudo; Glomerulonefritis membranosa; Membranous glomerulonephritis; Strongyloides stercolaris.

Publication types

Case Reports

MeSH terms

Animals
Cryptococcosis / complications
Delayed Diagnosis
Drug Therapy, Combination
Ecuador / ethnology
Enterococcus faecium
Escherichia coli Infections / complications
Fatal Outcome
Glomerulonephritis, Membranous / complications*
Glomerulonephritis, Membranous / drug therapy
Glomerulonephritis, Membranous / urine
Gram-Positive Bacterial Infections / complications
Humans
Immunocompromised Host
Immunosuppressive Agents / adverse effects*
Immunosuppressive Agents / therapeutic use
Lung Diseases, Fungal / complications
Male
Meningitis, Bacterial / complications
Middle Aged
Pneumonia, Bacterial / complications
Prednisone / adverse effects*
Prednisone / therapeutic use
Shock, Septic / etiology
Spain
Stenotrophomonas maltophilia
Strongyloides stercoralis*
Strongyloidiasis / complications*
Strongyloidiasis / diagnosis
Systemic Inflammatory Response Syndrome / etiology*

Substances

Immunosuppressive Agents
Prednisone