STAPHYLOCOCCUS-ASSOCIATED GLOMERULONEPHRITIS MIMICKING IGA VASCULITIS IN AN ADULT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Staphylococcus-associated glomerulonephritis (SAGN) is an immune complex–mediated (GN) which commonly presents with elevated creatinine, microscopic hematuria, and variable proteinuria; but on rare occasions may manifest as vasculitis that closely mimics Henoch-Schonlein Purpura (HSP). CASE PRESENTATION: A 62-year-old male diabetes mellitus (DM) liver cirrhosis presented gangrene of the right hallux after a dog bite. Given concern for gas gangrene, he underwent Guillotine amputation. Blood cultures were positive Methicillin sensitive staphylococcus aureus (MSSA). He was admitted to ICU septic shock started vasopressors broad-spectrum antibiotics. His course complicated by acute kidney injury (AKI) new onset diffuse palpable purpuric rash day 3 admission, skin biopsy performed. serum creatinine 1.4 mg/dl admission progressively worsened 2.8 requiring continuous renal replacement therapy (CRRT) initiation. Urinalysis showed 1+ protein large blood 20-40 red cells (RBC) per high power field. Urine microscopy revealed isomorphic RBC without cell cast. Spot protein-creatinine ratio 0.4 mg/g. Immune work up negative except hypocomplementemia C3 35 mg/dl, C4 8 CH50 19 unit/ml. Ultrasound abdomen cirrhosis. 2D-echocardiogram vegetations. Transesophageal echocardiogram not performed patient hemodynamically unstable. remained critically ill continued decline despite initiation CRRT died due refractory shock. Skin returned later, showing leukocytoclastic IgA deposition, confirming vasculitis. DISCUSSION: SAGN complex mediated disease occurs concurrently staphylococcal infection. Pathophysiology postulated involve massive T B activation superantigen. This leads release cytokines overproduction antibodies systemic IgA-staphylococcal antigen formation deposition. About 20% patients present can clinically mimic steroid responsive processes such HSP or cryoglobulinemic Renal essential establish diagnosis immunosuppression use in remain controversial worsen infection well disease. Unfortunately, could be this shock; however, being preferred owing clinical characteristics like older age, DM, active MSSA AKI hypocomplementemia. CONCLUSIONS: It important make clinicians aware presentation related GN, SAGN, HSP-nephritis, post-streptococcal GN treatment might differ. REFERENCE #1: 1. Akio Koyama, Kobayashi M et al. Glomerulonephritis associated MRSA infection: possible role bacterial Kidney International. Doi:10.1038/ki.1995.25 #2: 2. Tahrin Mahmood, Puckrin R Staphylococcus-Associated Mimicking Cryoglobulinemic epidural abscess: case report brief review literature. Can J Health Dis. 2018. Doi:10.1177/2054358118776325. DISCLOSURES: No relevant relationships kalpana chintha, source=Web Response Stanley Dumond, Adam Green, Ananya Nanduri, Matk Sunga,