Concomitant rapidly progressive glomerulonephritis and acute rheumatic fever after streptococcus infection: a case report

ABSTRACT

Acute post-streptococcal glomerulonephritis (APSGN) and acute rheumatic fever (ARF) are common immune-mediated complications after group A streptococcus (GAS) infection. The causative antigenic epitopes on GAS are different for APSGN and ARF, and their simultaneous occurrence is uncommon. A 12-year-old boy presented with fever and gross haematuria. He had subcutaneous nodules on the dorsum of both feet along with a new holosystolic murmur at the apex, and he developed hypertension and generalised oedema after admission. Investigation confirmed the diagnosis of ARF with APSGN. He received a corticosteroid to control inflammation of both the conditions. His clinical signs gradually improved but he still had rheumatic heart disease. As both diseases can occur in the same patient, treatment should be provided for both conditions.

Abbreviations: APSGN: acute post-streptococcal glomerulonephritis; ARF: acute rheumatic fever; ASO: antistreptolysin O; Cr: serum creatinine; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GAS: group A streptococcus; RBC: red blood cells; RPGN: rapidly progressive glomerulonephritis; S1: first heart sound; S2: second heart sound; TTE: transthoracic echocardiogram.

KEYWORDS:

• rapidly progressive glomerulonephritis
• acute rheumatic fever
• post-streptococcal infection
• group A streptococcus

Acknowledgments

We would like to thank Vajira Hospital, Navamindradhiraj University for providing all the expenses incurred for the publication of this manuscript. The study was approved by the ethics committee of the Vajira Hospital, Navamindradhiraj University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributions

OS (corresponding author) conceived the study, applied for ethics permission, wrote the first draft of the manuscript, undertook the literature search, added intellectual content and was involved in all aspects of the paper. SP wrote the first draft of the manuscript and added intellectual input. SE and YA corrected and edited the manuscript. CC described the histopathological analysis results and provided images. All authors have approved the final version of the manuscript.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Suwanna Pornrattanarungsi

Suwanna Pornrattanarungsi (Paediatric Cardiologist) is an Assistant Professor of Paediatrics.

Sudarat Eursiriwan

Sudarat Eursiriwan (Paediatric Cardiologist) is an Assistant Professor of Paediatrics.

Yupaporn Amornchaicharoensuk

Yupaporn Amornchaicharoensuk (Paediatric Nephrologis) is an Associate Professor of Paediatrics.

Chutima Chavanisakun

Chutima Chavanisakun is an Assistant Professor of Anatomical Pathology.

Ornatcha Sirimongkolchaiyakul

Ornatcha Sirimongkolchaiyakul (Paediatric Nephrologist) is an Assistant Professor of Paediatrics.