Glomerulonephritis in a patient with chronic active Epstein-Barr virus infection
Abstract
Renal involvement is rare in chronic active Epstein-Barr virus (EBV) infection. We report an 11-year-old girl who had focal mesangial proliferative glomerulonephritis with cellular crescents and renal tubular atrophy with foam cells in the lumen at the time of the first admission. However, the patient was not diagnosed with chronic active EBV infection until the third admission, 18 months later, because she did not exhibit typical clinical manifestations of infectious mononucleosis, i.e., fever, lymphadenopathy, hepatomegaly, or increased atypical lymphocytes. We performed in situ hybridization of EBV in renal biopsy and renal autopsy tissue and found EBV genome-positive cells in the enlarged vascular areas surrounding the renal tubules in both specimens. The relationship between mesangial proliferative glomerulonephitis with crescents and chronic active EBV infection is unknown.
Keywords
Chronic active Epstein-Barr virus infection Glomerulonephritis Infectious mononucleosis In situ hybridization Renal biopsyReferences
- 1.Rickinson AB (1986) Chronic, symptomatic Epstein-Barr virus infections. Immunol Today 7:13–14CrossRefGoogle Scholar
- 2.Ishihara S, Okada S, Wakiguchi H, Kurashige T, Morishima T, Kawa-Ha K (1995) Chronic active Epstein-Barr virus infection in children in Japan. Acta Paediatr 84:1271–1275PubMedGoogle Scholar
- 3.Muso E, Fujiwara H, Yoshida H, Hosokawa R, Yashiro M, Hongo Y, Matumiya T, Yamabe H, Kikuta H, Hironaka T, Hirai K, Kawai C (1993) Epstein-Barr virus genome-positive tubulointerstitial nephritis associated with Kawasaki disease-like coronary aneurysms. Clin Nephrol 40:7–15PubMedGoogle Scholar
- 4.Joh K, Kanetsuna Y, Ishikawa Y, Aizawa S, Imadachi A, Tastusawa O, Ohishi T (1998) Epstein-Barr virus genome-positive tubulointerstitial nephritis associated with immune complex-mediated glomerulonephritis in chronic active EB virus infection. Virchows Arch 432:567–573CrossRefPubMedGoogle Scholar
- 5.Nadasdy T, Park C-S, Peiper SC, Wenzl JE, Oates J, Silva FG (1992) Epstein-Barr virus infection-associated renal disease: diagnostic use of molecular hybridization technology in patients with negative serology. J Am Soc Nephrol 2:1734–1742PubMedGoogle Scholar
- 6.Mayer HB, Wanke CA, William M, Crosson AW, Federmann M, Hammer SM (1996) Epstein-Barr virus-induced infectious mononucleosis complicated by acute renal failure: case report and review. Clin Infect Dis 22:1009–1018PubMedGoogle Scholar
- 7.Arm JP, Rainford DJ, Turk EP (1984) Acute renal failure and infectious mononucleosis. J Infect 9:293–297PubMedGoogle Scholar
- 8.Andres GA, Kano K, Elwood C, Prezyna A, Sepulveda M, Milgrom F (1976) Immune deposit nephritis in infectious mononucleosis. Int Arch Allergy Appl Immunol 52:136–144PubMedGoogle Scholar
- 9.Cunningham MA, Huang XR, Dowling JP, Tipping PG, Holdsworth SR (1999) Prominence of cell-mediated immunity effectors in “pauci-immune” glomerulonephritis. J Am Soc Nephrol 10:499–506PubMedGoogle Scholar
- 10.Mori N, Yamashita Y, Tsuzuki T, Nakayama A, Nakazawa M, Hasegawa Y, Kojima H, Nagasawa T (2000) Lymphomatous features of aggressive NK cell leukaemia/lymphoma with massive necrosis, haemophagocytosis and EB virus infection. Histopathology 37:363–371CrossRefPubMedGoogle Scholar
- 11.Scoholey RT, Carey RW, Miller G, Henle W, Eastman R, Mark EJ, Kenyon K, Wheeler EO, Rubin RH (1981) Chronic Epstein-Barr virus infection associated with fever and interstitial pneumonia; clinical and serogic features and response to antiviral chemotherapy. Ann Intern Med 104:636–643Google Scholar