Henoch–Schonlein purpura, post-streptococcal glomerulonephritis and acute rheumatic carditis after Group A β-haemolytic streptococcal infection
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Date
2018
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Abstract
Besides association with acute rheumatic fever (ARF) and acute glomerulonephritis (APSGN), in up to 40% of cases, Group A β-haemolytic streptococcal (GABHS) infections are also implicated as a trigger for Henoch–Schonlein purpura (HSP). A 7-year-old girl with GABHS throat infection who developed HSP, APSGN and rheumatic carditis is reported. She presented with palpable purpura and arthritis in both ankles and later developed carditis characterised by mitral/aortic regurgitation and glomerulonephritis characterised by mixed nephritic/nephrotic syndrome. She had a raised anti-streptolysin titre (ASOT), blood urea nitrogen and creatinine and hypocomplementaemia (C3), and renal biopsy demonstrated endocapillary and extracapillary proliferative glomerulonephritis with crescents. Immunofluorescence microscopy demonstrated a ‘full house’ of immunoglobulin and complement, viz. IgA + 2, IgG + 3, IgM + 2, C3c + 1, Clq + 2 with predominantly IgG deposition. One week earlier, her 4-year-old sister had presented to another hospital with HSP complicated by microscopic haematuria, nephrotic-range proteinuria and gastro-intestinal involvement, and with raised ASOT and low C3 levels. Although HSP has been associated with either ARF or APSGN, this is the first case of a child with HSP, ARF and APSGN in combination. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
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Keywords
Antistreptolysin , Biopsy , Child , Complement System Proteins , Creatinine , Female , Glomerulonephritis , Histocytochemistry , Humans , Immunohistochemistry , Kidney , Microscopy , Microscopy, Fluorescence , Purpura, Schoenlein-Henoch , Rheumatic Heart Disease , Streptococcal Infections , Urea , acetylsalicylic acid , albumin , antistreptolysin , C reactive protein , complement component C1q , complement component C3 , complement component C3c , complement component C4 , creatinine , enalapril , furosemide , hemoglobin , immunoglobulin A , immunoglobulin G , immunoglobulin M , methylprednisolone , penicillin derivative , prednisolone , antistreptolysin , complement , creatinine , urea , acute rheumatic carditis , allergic glomerulonephritis , anaphylactoid purpura , aortic regurgitation , Article , ascites , bacterium culture , blood culture , body temperature , carditis , case report , central venous pressure , child , clinical article , diastolic heart murmur , disease association , disease severity , echocardiography , edema , erythrocyte sedimentation rate , female , group A streptococcal infection , hematuria , human , hypertension , immunofluorescence microscopy , kidney biopsy , leukocyte count , lung auscultation , mitral valve regurgitation , occult blood , onset age , percussion , platelet count , pleura effusion , proliferative glomerulonephritis , protein urine level , proteinuria , pulse rate , purpuric rash , school child , symptom , systolic heart murmur , tachypnea , thorax radiography , urea nitrogen blood level , urine sediment , anaphylactoid purpura , biopsy , blood , complication , cytochemistry , fluorescence microscopy , glomerulonephritis , immunohistochemistry , kidney , microscopy , pathology , rheumatic heart disease , Streptococcus infection