Tubulointerstitial nephritis with IgG4-positive plasma cell infiltration and tertiary lymphoid tissue in a patient with cryoglobulinemic vasculitis: a case report.

Tertiary lymphoid tissue (TLT) develops at sites of chronic immune stimulation, including infection, autoimmune disease, transplant rejection, and cancer. Recently, TLT has been focused on an indicator for poor renal prognosis in various kidney diseases. In cryoglobulinemic vasculitis (CV), specific glomerular and vascular lesions are seen; however, tubulointerstitial lesions are usually nonspecific. We herein report the case of a 74-year-old man with idiopathic CV with rare tubulointerstitial lesions, such as tubulointerstitial nephritis (TIN) with IgG4-positive plasma cell infiltration and TLT. To our knowledge, this is the first report identifying TLT in the kidney biopsy in a patient with CV. Glucocorticoid improved the renal outcome. The association between CV and TIN with TLT remains unknown.

Streptococcal Infection-related Glomerulonephritis in an Elderly Diabetic Patient Complicated by Hemophagocytic Syndrome and Cytomegalovirus Nephritis.

There has been a significant shift in epidemiology and renal outcomes of infection-related glomerulonephritis (IRGN) in recent years. The renal prognosis of IRGN is often poor in adults, especially in the elderly and diabetics. We herein report an elderly diabetic patient with IRGN due to streptococcal infection complicated by hemophagocytic syndrome and cytomegalovirus nephritis, which is uncommon among non-transplant patients. Infection control and steroids did not recover the patient's renal function. For elderly IRGN patients with diabetes, a further investigation of the most effective treatment for related renal outcomes is needed.

Biopsy-proven Streptococcus suis-associated Infectious Glomerulonephritis.

A 64-year-old Japanese man who worked at a butcher shop was hospitalized for a fever, headache, and deafness. We diagnosed him with sepsis and meningitis caused by Streptococcus suis infection. The patient's renal function declined rapidly, and hemodialysis was performed temporarily. A renal biopsy was performed, and the renal function tended to improve with antimicrobial therapy. This case seemed rather similar to one of staphylococcal-associated nephritis in that it showed mesangial proliferative nephritis with immunoglobulin A deposition, even though the nephritis was caused by streptococci. Similarly, intramembranous electron-dense deposits were characteristic findings. We present new findings of an in vivo renal biopsy in a case of S. suis-associated glomerulonephritis.

Cytokine nephropathy in a patient with fatal Epstein-Barr virus-associated hemophagocytic syndrome.

Occasionally, patients with acute Epstein-Barr virus (EBV) infection develop hemophagocytic syndrome (HPS). Acute kidney injury (AKI) is considered a strong prognostic factor, but very few data are available about the biopsy-proven renal involvement of EBV-HPS. Here we describe a previously healthy 17-year-old girl with EBV-HPS. Combination therapy failed and renal necropsy was performed. The renal histology showed that intact glomeruli, remarkable interstitial edema and some cellular infiltration, and protein casts. These findings were compatible with cytokine nephropathy as recently advocated. We suggest that hypercytokinemia may play an important role in the pathophysiology in AKI of EBV-HPS.

[Infective endocarditis successfully treated by early medical therapy in a patient with Henoch-Schönlein purpura nephritis under oral steroid therapy].

A 29-year-old man was admitted to our hospital because of high fever and dyspnea. About two months before this admission the patient was diagnosed as Henoch-Schönlein purpura nephritis who was treated with 40 mg/day of prednisolone(PSL). When the dose of PSL was decreased to 32.5 mag/day, his temperature was 40 degrees C, the pulse was 120 beats per minute and the blood pressure was 71/36 mmHg. In the peripheral blood study, the white blood cell count was 23,800/microL and C-reactive protein was 6.1 mg/dL. He was diagnosed as bilateral lower lung pneumonia by chest-computed tomography findings, non-segmental and high-density consolidation of the bilateral lower lungs. Streptococcus pneumoniae was detected from blood culture. Therefore it was concluded that sepsis was caused by severe pneumonia. Thereafter infective endocarditis was diagnosed from the findings of vegetation of both the tricuspid and mitral valves detected by ultrasonic cardiography. Infective endocarditis resulted from septicemia caused by Streptococcus pneumoniae. The infection related endocarditis was completely healed by early treatment including an adequate quantity of penicillin G with high sensitivity. There have been few case reports of infective endocarditis in patients with nephritis under steroid therapy. Steroid therapy is widely used in patients with various types of nephritis including IgA nephropathy and focal segmental glomerular sclerosis in addition to Henoch-Shönlein purpura. Infective endocarditis should be recognized as a complication of steroid treatment of these patients.

Adult staphylococcus scalded skin syndrome in a peritoneal dialysis patient.

Staphylococcal scalded skin syndrome (SSSS), a generalized exfoliative dermatitis complicating infections by exfoliative toxin-producing strains of Staphylococcus aureus, is rarely observed in adults, especially in those with chronic renal failure. In contrast to the mortality in infants, the mortality in adults is usually high. A case of generalized SSSS in a peritoneal dialysis patient is reported. A-62-year old Japanese man in whom peritoneal dialysis had been carried out was admitted to our hospital with acute peritonitis. It was intractable peritonitis in terms of resistance to various antibiotics; however, improvement of the peritonitis was shown after the injection of vancomycin. Nine days after the completion of this medication, erythema appeared in the eyes and mouth, and around the nostrils, with an exothermic reaction at 39.0 degrees C. Radial cracks formed in the face within a few days, and the erythema rapidly expanded to the neck, axilla, the whole body. The blood pressure was also lowered, and this led to a state of shock. Culture of skin biopsy specimens yielded identical strains of S. aureus. A presumptive diagnosis of SSSS was made. The patient was treated with antibiotics that were effective against the organisms and with both fluid supplementation and dopamine, resulting in subsidence of the signs and symptoms. The exothermic reaction and skin symptoms were improved promptly, with improvement in the general condition, including the state of shock. This appears to be the first reported case of SSSS caused by S. aureusin an adult patient with peritoneal dialysis who was treated successfully. It is very important that SSSS be differentiated from toxic epidermal necrosis, as the treatment is different.