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Glomerulonephritis and nephrotic syndrome in a child with DiGeorge syndrome: Answers

  • Leo ArkushEmail author
  • Orli Megged
  • Itamar Nitzan
  • Nurit Yaakobi-Simhayoff
  • Sofia Feinstein
  • Shimrit Tzvi-Behr
Clinical Quiz
  • 3 Downloads

Answers

  1. 1.

    The findings on eye examination are consistent with Roth spots. In view of her background of congenital cardiac disease with the presence of an indwelling cardiac conduit, the most likely diagnosis is bacterial infective endocarditis with secondary immunologic sequelae including glomerulonephritis.

     
  2. 2.

    The next step in evaluation and management is taking repeated sets of blood cultures and commencing empirical antibiotic treatment. In our patient, three repeated sets of blood cultures were positive for Leptotrichia goodfellowii, a rare, slow-growing anaerobe. Antibiotic treatment was adapted as per sensitivities of the bacteria and she received a total of 6 weeks parenteral antibiotic therapy.

     
  3. 3.

    The recommended management for her glomerulonephritis with nephrotic syndrome is treating the causative agent with antibiotics, supportive care, in particular controlling hypertension. In rare cases, immunosuppressive therapy has been used for the treatment of non-responding...

Keywords

Infective endocarditis Glomerulonephritis Nephrotic syndrome DiGeorge syndrome 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Le Moing V, Lacassin F, Delahousse M, Duval X, Longuet P, Leport C, Vildé JL (1999) Use of corticosteroids in glomerulonephritis related to infective endocarditis: three cases and review. Clin Infect Dis 28:1057–1061CrossRefGoogle Scholar
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    Boils CL, Nasr SH, Walker PD, Couser WG, Larson CP (2015) Update on endocarditis associated glomerulonephritis. Kidney Int 87:1241–1249CrossRefGoogle Scholar
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    Martin JM, Neches WH, Wald ER (1997) Infective endocarditis: 35 years of experience at a children’s hospital. Clin Infect Dis 24:669–675CrossRefGoogle Scholar
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    Caram LB, Linefsky JP, Read KM, Murdoch DR, Lalani T, Woods CW, Reller LB, Kanj SS, Premru MM, Ryan S, Al-Hegelan M, Donnio PY, Orezzi C, Paiva MG, Tribouilloy C, Watkin R, Harris O, Eisen DP, Corey GR, Cabell CH, Petti CA, International Collaboration on Endocarditis Investigator Group (2008) Leptotrichia endocarditis: report of two cases from the International Collaboration on Endocarditis (ICE) database and review of previous cases. Eur J Clin Microbiol Infect Dis 27:139–143CrossRefGoogle Scholar
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    Matias WR, Bourque DL, Niwano T, Onderdonk AB, Katz JT (2016) Subacute bacterial endocarditis with Leptotrichia goodfellowii in a patient with a valvular allograft: a case report and review of the literature. Case Rep Infect Dis 2016:3051212Google Scholar

Copyright information

© IPNA 2019

Authors and Affiliations

  • Leo Arkush
    • 1
    Email author
  • Orli Megged
    • 1
    • 2
  • Itamar Nitzan
    • 1
  • Nurit Yaakobi-Simhayoff
    • 1
    • 3
  • Sofia Feinstein
    • 1
    • 4
  • Shimrit Tzvi-Behr
    • 1
    • 4
  1. 1.Wilf Children’s Hospital, Pediatric DepartmentShaare Zedek Medical CenterJerusalemIsrael
  2. 2.Pediatric Infectious Diseases UnitShaare Zedek Medical CenterJerusalemIsrael
  3. 3.Pediatric Cardiology UnitShaare Zedek Medical CenterJerusalemIsrael
  4. 4.Division of Pediatric NephrologyShaare Zedek Medical CenterJerusalemIsrael

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