Chronic catheter-linked bacteremia of Pseudomonas stutzeri etiology as a cause of membranous proliferative glomerulonephritis (MPGN) – a case report


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Pol Merkur Lekarski. Oct 22, 2021; 49 (293): 364-367.

ABSTRACT

Membrane-proliferative secondary glomerulonephritis most often develops during viral infections (HCV, HBV), autoimmune diseases, paraproteinemia and also during chronic bacterial infections. Pseudomonas stutzeri (P. stutzeri) infections are extremely rare and usually not very symptomatic. The natural habitat of this bacterium is soil and water. However, in the event of P. stutzeri infection, especially in patients who are frequently hospitalized or receiving immunosuppressive drugs, environmental contamination in healthcare establishments must be taken into account when investigating the origin of the disease. ‘infection.

A CASE REPORT: A 60 year old man with a history of smoking and high blood pressure with a vascular chamber in the superior vena cava (SCV) after treatment for bladder cancer (stage G2 / G3) ago several years has been described. The patient underwent the TURBT procedure, then received intravesical infusions of BCG for 3 years, followed by complications in the form of severe dysuria and lower abdominal pain. Due to severe nausea and the inability to take oral pain relievers, the patient was ordered to insert a vascular port into the VCS in order to continue analgesic and anti-inflammatory therapy. Several years later, after the onset of massive edema of the lower extremities, the patient was subjected to a 24-hour urine collection, during which the proteinuria amounted to approx. 13 g / day, followed by a diagnostic renal biopsy. Histopathological examination described membranoproliferative glomerulonephritis (MPGN). Other renal parameters were also abnormal, i.e. the serum creatinine concentration was 1.9 mg / dl and the serum urea concentration was 116 mg / dl. Immunosuppressive therapy was started. The patient received intravenous methylprednisolone followed by oral prednisone and oral cyclosporine. During the initial period of immunosuppressive therapy, the serum levels of ciclosporin were insufficient (starting at 26.34 ng / ml), which led to her dose being increased to finally reach 175 mg / day. After several months of treatment, the patient was hospitalized again, due to a respiratory tract infection that had lasted for several weeks and was not suitable for antibiotic therapy. The deterioration of renal parameters and the increase in inflammatory markers suggested the diagnosis of catheter-related sepsis. P. stutzeri was cultured from the material taken from the catheter and from the patient’s blood. Appropriate antibiotic therapy was started and after improvement of the patient’s condition, cyclosporine treatment was resumed, which was discontinued after the diagnosis of bacteremia. Rapid remission was obtained, allowing the discontinuation of immunosuppressive drugs.

CONCLUSIONS: Chronic asymptomatic infection with a rare pathogen, such as Pseudomonas stutzeri, was probably the cause of glomerulonephritis. After removal of the port and antibiotic therapy, disease remission was achieved.

PMID:34800025


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