Fluctuating levels of anti-GBM antibodies following a fungal infection in a patient with secondary amyloidosis
Tsagalis, G.C.; Margelos, V.; Nikolopoulou, N.; Hadjiconstantinou, V.E.
Clinical Nephrology 59(2): 150-152
2003
ISSN/ISBN: 0301-0430 PMID: 12608561 Document Number: 566003
A case of a 62-year-old female from Greece who was admitted due to generalized oedema and pain in the right calf is presented. Ultrasonography of the right leg revealed occlusion of the superficial femoral and popliteal veins confirming deep vein thrombosis. The patient was started with dicoumarol for the deep vein thrombosis and intravenous furosemide for the oedema. From the 4th to the 5th hospital day, the patient's renal function rapidly deteriorated. Anticoagulants were discontinued and a renal biopsy was performed. Pending results, intravenous methylprednisolone 500 mg for 3 consecutive days followed by oral prednisolone 50 mg/day were prescribed. Despite aggressive treatment, the renal function further deteriorated and the patient was supported with haemodialysis. Anti-glomerular basement membrane (GBM) antibodies were initially negative but another 2 consecutive measurements yielded positive results (4.17 ng/ml and 4.83 ng/ml). After 3 days of steroid therapy, the patient developed severe mycoses in the lungs, caused by Aspergillus fumigatus identified in bronchoalveolar lavage and sputum cultures. The steroids were tapered and the patient was started on liposomal amphotericin B followed by itraconazole 400 mg/day for one year. The lung infection was controlled. On follow up after 15 days, anti-GBM antibodies were negative and after 6 months, with the patient still under regular haemodialysis, anti-GBM antibodies remained within normal limits.