[Acute renal failure and rare severe complication of systemic steroid treatment in a 73-year-old woman]

Internist (Berl). 2019 Nov;60(11):1201-1208. doi: 10.1007/s00108-019-00677-z.
[Article in German]

Abstract

This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.

Keywords: Hyperinfection; Immunosuppression; Ivermectin; Prednisolone; Strongyloides stercoralis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Kidney Injury / etiology*
  • Aged
  • Animals
  • Antiparasitic Agents / therapeutic use
  • Fatal Outcome
  • Female
  • Glomerulonephritis / diagnosis
  • Glomerulonephritis / drug therapy*
  • Humans
  • Ivermectin / therapeutic use
  • Prednisolone / adverse effects*
  • Prednisolone / therapeutic use
  • Steroids / adverse effects*
  • Steroids / therapeutic use
  • Stomach / microbiology
  • Stomach / pathology
  • Strongyloides stercoralis / isolation & purification*
  • Strongyloidiasis / complications
  • Strongyloidiasis / diagnosis*
  • Strongyloidiasis / drug therapy

Substances

  • Antiparasitic Agents
  • Steroids
  • Ivermectin
  • Prednisolone