RESUMEN
A 70-year-old lung transplant recipient patient was admitted with fever, nausea, abdominal pain, peripheral edema and pronounced weakness. An initial work-up for presumed infection revealed cholestatic hepatitis, leukocytosis and thrombocytopenia, but failed to detect a pathogen. An increased glucose uptake exclusively in the liver was demonstrated by positron emission tomography. Liver biopsy showed basophilic inclusions in the cytoplasm of hepatocytes. Broad- range 16S rRNA gene PCR followed by sequence analysis yielded Spiroplasma sp. in two independent blood samples and the liver biopsy, confirming Spiroplasma sp. as the causative agent. Antibiotic treatment with doxycycline and azithromycin led to complete recovery.
Asunto(s)
Infecciones por Bacterias Gramnegativas/microbiología , Hepatitis/microbiología , Huésped Inmunocomprometido , Trasplante de Pulmón , Spiroplasma/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , ADN Bacteriano/genética , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico por imagen , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Hepatitis/diagnóstico por imagen , Hepatitis/tratamiento farmacológico , Humanos , Enfermedades Pulmonares Intersticiales/cirugía , Reacción en Cadena de la Polimerasa , Pronóstico , ARN Ribosómico 16S/genética , CintigrafíaRESUMEN
HISTORY AND ADMISSION FINDINGS: A 72-year-old man with nausea, fever and elevated inflammatory parameters was transferred for further diagnostic assessment and treatment. On examination a palpable purpura was obvious without any signs of infection. INVESTIGATIONS: Creatininekinase was 350 mmol/l with a proteinuria of 20 g per day. Histological examination revealed hypersensitivity vasculitis in the cutis and a membranoproliferative glomerulonephritis. In addition there was a mixed cryoglobulinemia with a negative test for hepatitis C virus. Further investigation revealed hepatitis C virus RNA genotype 1 b in the cryoprecipitate. DIAGNOSIS AND TREATMENT: The patient was successfully treated with with interferon alpha for 12 month. The nephrotic syndrome improved and the proteinuria ceased CONCLUSION: Mixed cryoglobulinemias are associated with hepatitis C virus infection in over 80% of cases. Normally it is easy to make the diagnosis serologically with an ELISA test. But in a few cases the virus RNA is only detectable in the cryoprecipitate. If there is a high suspicion of an hepatitis C infection with cryoglobulinemia but HCV serology is negative, it is essential that virus antigen and antibodies are searched for in the cryoprecipitate.