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Atypical anti-glomerular basement membrane disease complicated by methicillin-susceptible Staphylococcus aureus infection-related rapidly progressive glomerulonephritis: a case report and literature review

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Abstract

Atypical anti-glomerular basement membrane (GBM) disease, which is characterized by low levels of or negativity for anti-GBM antibodies in circulation but positivity in the kidney, has been recognized in this decade. However, a therapeutic strategy has not been established to date because its outcome is better than that of classic anti-GBM disease. This case report and literature review highlight atypical anti-GBM disease in infection-related rapidly progressive glomerulonephritis. A 72-year-old Japanese man diagnosed with methicillin-susceptible Staphylococcus aureus (MSSA)-induced vertebral osteomyelitis experienced for 2 months was referred to our hospital because of renal insufficiency. He developed rapidly progressive glomerulonephritis with a serum creatinine level of 6.8 mg/dL, C-reactive protein level of 9.7 mg/dL, urinary protein-to-creatinine ratio of 3.37 g/gCr, and gross hematuria. The serum anti-GBM antibody concentration was 3.5 U/mL, which was slightly above the normal range (< 3.0 U/mL). Conservative treatment, mainly with antibiotics, improved the symptoms and renal function. The serum anti-GBM antibody concentration peaked at 4.0 U/mL on day 7 and decreased to an undetectable range at the end of eight-week antibiotic therapy. This is the first case report describing the presentation and disappearance of serum anti-GBM antibody in a patient with MSSA infection. Conservative treatment may be effective for patients with atypical anti-GBM disease complicated by infectious diseases.

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Authors and Affiliations

  1. Department of Nephrology, Asahikawa Red Cross Hospital, 1jo 1 chome, Akebono, Asahikawa, Hokkaido, Japan

    Tomohisa Yamashita, Komei Sato, Keitaro Nishizawa, Yuka Matsuhisa & Hironori Kobayashi

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  1. Tomohisa Yamashita
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  2. Komei Sato
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  3. Keitaro Nishizawa
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  4. Yuka Matsuhisa
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  5. Hironori Kobayashi
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Correspondence to Tomohisa Yamashita.

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Written informed consent was obtained from the patient for submitting this case report to English language journals.

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Yamashita, T., Sato, K., Nishizawa, K. et al. Atypical anti-glomerular basement membrane disease complicated by methicillin-susceptible Staphylococcus aureus infection-related rapidly progressive glomerulonephritis: a case report and literature review. CEN Case Rep 10, 348–353 (2021). https://doi.org/10.1007/s13730-020-00564-9

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  • DOI: https://doi.org/10.1007/s13730-020-00564-9

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