amphotericin-b and Glomerulonephritis

Topics: Acute Kidney Injury; Amphotericin B; Anti-Bacterial Agents; Cephalosporins; Glomerulonephritis; Humans; Kidney Diseases; Nephritis, Interstitial; Penicillins; Polymyxins; Tetracyclines; Vasculitis

A case of disseminated infection caused by Penicillium chrysogenum in a 10-year-old boy with a history of Henoch-Schönlein purpura and proliferative glomerulonephritis, treated with immunosuppressors, is reported herein. The patient had a clinical picture of 2 weeks of fever that did not respond to treatment with broad-spectrum antibiotics and amphotericin B. Computed tomography imaging showed diffuse cotton-like infiltrates in the lungs, hepatomegaly, mesenteric lymphadenopathy, and multiple well-defined round hypodense lesions in the spleen. His treatment was changed to caspofungin, followed by voriconazole. One month later, a splenic biopsy revealed hyaline septate hyphae of >1μm in diameter. Fungal growth was negative. However, molecular analysis showed 99% identity with P. chrysogenum. A therapeutic splenectomy was performed, and treatment was changed to amphotericin B lipid complex and caspofungin. The patient completed 2 months of treatment with resolution of the infection. P. chrysogenum is a rare causative agent of invasive fungal infections in immunocompromised patients, and its diagnosis is necessary to initiate the appropriate antifungal treatment.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Caspofungin; Child; Echinocandins; Fever; Glomerulonephritis; Humans; Hyalohyphomycosis; IgA Vasculitis; Immunocompromised Host; Kidney Failure, Chronic; Lipopeptides; Male; Penicillium chrysogenum; Spleen; Splenectomy; Tomography, X-Ray Computed; Treatment Outcome; Voriconazole

Renal involvement is an unusual complication of human visceral leishmaniasis (VL). The kidney lesions are characterized more by interstitial damage than glomerular or vascular damage. This case represents a 20 years-old man admitted with pancytopenia, purpura, acute renal failure, and nephrotic syndrome associated with heavy proteinuria. The diagnosis of VL was made on bone marrow smear cytology where Leishmania amastigotes were found. The renal biopsy revealed a segmental necrotising glomerulonephritis with 70% crescents. Treatment with liposomal amphotericine B alone has been ineffective on the course of renal failure, however, partial recovery was obtained after the administration of high dose corticosteroids. We present the various clinical, biological, and histological aspects of this case, from the south of France. It gave us the opportunity to discuss these unusual manifestations of immunomediated necrotising skin and renal lesions.

Topics: Acute Kidney Injury; Adult; Amphotericin B; Antiprotozoal Agents; Glomerulonephritis; Glucocorticoids; Humans; Leishmaniasis, Visceral; Male; Methylprednisolone; Necrosis

A case of invasive pulmonary aspergillosis and nocardiosis following high dose prolonged steroid therapy given for suspected rapidly progressive glomerulonephritis is reported. A favourable response was achieved with a combination of amphotericin B and cotrimoxazole. A high index of suspicion and aggressive investigations are necessary for confirmation of diagnosis and early institution of appropriate therapy.

Topics: Amphotericin B; Aspergillosis, Allergic Bronchopulmonary; Glomerulonephritis; Humans; Immunocompromised Host; Male; Methylprednisolone; Middle Aged; Nocardia Infections; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

Five cases of disseminated histoplasmosis complicating renal transplantation are reported. Nine previously reported cases from the literature are reviewed. In this setting disseminated histoplasmosis usually presents as a nonspecific systemic febrile illness that may be fulminant or more subacute. Five of 14 patients presented with skin lesions; only one patient presented with primary pulmonary symptoms of cough and dyspnea. Three of our patients and three others previously reported on survived the infection and maintained good function in the transplanted kidney despite prolonged therapy with amphotericin B. Immunosuppression was the only predisposing factor that could be identified with certainty in the five patients reported on herein. However, in two of the five patients the onset of disseminated histoplasmosis coincided with a well documented cytomegalovirus infection; the viral infection may have been a factor predisposing to infection in these two cases.

Topics: Adult; Amphotericin B; Female; Glomerulonephritis; Histoplasmosis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Polycystic Kidney Diseases; Transplantation, Homologous