Takahisa Kimata1, Shoji Tsuji1, Ken Yoshimura1, Hiroyasu Tsukaguchi2, Kazunari Kaneko3. 1. Department of Pediatrics, Kansai Medical University, 2-3-1 Shin-machi, Hirakata-shi, Osaka, 573-1191, Japan. 2. 2nd Department of Internal Medicine, Kansai Medical University, 2-3-1 Shin-machi, Hirakata-shi, Osaka, 573-1191, Japan. 3. Department of Pediatrics, Kansai Medical University, 2-3-1 Shin-machi, Hirakata-shi, Osaka, 573-1191, Japan. kanekok@hirakata.kmu.ac.jp.
Abstract
BACKGROUND: Methicillin-resistant Staphylococcus aureus-associated glomerulonephritis (MRSA-GN), a syndrome in which superantigens play an important role in the pathogenesis of the infection, has been well described in adult patients but not previously recognized in children. CASE DIAGNOSIS/TREATMENT: We report the case of a 6-year-old girl with MRSA-GN. She presented multiple malformations, including tracheal stenosis necessitating tracheotomy. She was admitted to our hospital because of acute pneumonia caused by a MRSA infection and was found to have proteinuria and abnormal renal function. MRSA was detected in her sputum, and this MRSA isolate produced toxic shock syndrome toxin-1, which acts as a superantigen and stimulates Vβ2(+) T cells. A blood test revealed that the number of circulating Vβ2(+) T cells expressing CD45RO, a marker of activation, was increased along with a concomitant elevation in the levels of serum immunoglobulins. Both are hallmarks of MRSA-GN. The eradication of MRSA using appropriate antibiotics resulted in the disappearance of the proteinuria; in contrast, corticosteroid treatment failed. To the best of our knowledge, this is the youngest patient to be diagnosed with MRSA-GN. CONCLUSIONS: In summary, there should be a high index of suspicion for MRSA-GN, even in the very young, in order to avoid the unnecessary use of immune suppressants in this context.
BACKGROUND: Methicillin-resistant Staphylococcus aureus-associated glomerulonephritis (MRSA-GN), a syndrome in which superantigens play an important role in the pathogenesis of the infection, has been well described in adult patients but not previously recognized in children. CASE DIAGNOSIS/TREATMENT: We report the case of a 6-year-old girl with MRSA-GN. She presented multiple malformations, including tracheal stenosis necessitating tracheotomy. She was admitted to our hospital because of acute pneumonia caused by a MRSA infection and was found to have proteinuria and abnormal renal function. MRSA was detected in her sputum, and this MRSA isolate produced toxic shock syndrome toxin-1, which acts as a superantigen and stimulates Vβ2(+) T cells. A blood test revealed that the number of circulating Vβ2(+) T cells expressing CD45RO, a marker of activation, was increased along with a concomitant elevation in the levels of serum immunoglobulins. Both are hallmarks of MRSA-GN. The eradication of MRSA using appropriate antibiotics resulted in the disappearance of the proteinuria; in contrast, corticosteroid treatment failed. To the best of our knowledge, this is the youngest patient to be diagnosed with MRSA-GN. CONCLUSIONS: In summary, there should be a high index of suspicion for MRSA-GN, even in the very young, in order to avoid the unnecessary use of immune suppressants in this context.
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