A case of IgA‒dominant infection‒related glomerulonephritis (IgA‒IRGN) associated with osteomyelitis in which it was possible to discontinue hemodialysis

Abstract

A 54‒year‒old male visited a hospital with lower back pain in August 2019 and was hospitalized with a diagnosis of osteomyelitis due to gangrene in the amputation stump of his left toe. He was transferred to our hospital on the 10th hospital day because the gangrene worsened, and his left lower thigh was amputated. Serratia marcescens was cultured from his wound. He presented with nephrotic syndrome involving renal dysfunction, hematuria, hypocomplementemia, and a high anti‒streptolysin O antibody titer. A histological examination of a renal biopsy showed endocapillary proliferative glomerulonephritis, and immunofluorescence analysis revealed that the glomeruli were predominantly IgA‒positive. Therefore, we diagnosed IgA‒dominant infection‒related glomerulonephritis (IgA‒IRGN). Hemodialysis was started on the 39th hospital day, when symptoms of uremia were observed, and vancomycin and ceftriaxone were administered for persistent vertebral osteomyelitis, which was revealed by computed tomography performed on admission. Hemodialysis was discontinued on the 61st hospital day because the patient’s renal function gradually improved. After the hemodialysis was discontinued, no deterioration of his renal function was observed, and he was discharged on the 133rd hospital day. Steroids have not been shown to be effective against IgA‒IRGN, and it is important to select appropriate antibiotics if such infections persist.