Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature
We present an unusual case of shunt nephritis in a 39-year-old male who presented 21 years after placement of a ventriculoperitoneal (VP) shunt. He complained of fevers, headaches, dizziness, and urticarial plaques on arms, trunks, and legs and was found to have anemia, low complement levels, elevat...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2017/1867349 |
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| author | Michael Babigumira Benjamin Huang Sherry Werner Wajeh Qunibi |
| author_facet | Michael Babigumira Benjamin Huang Sherry Werner Wajeh Qunibi |
| author_sort | Michael Babigumira |
| collection | DOAJ |
| description | We present an unusual case of shunt nephritis in a 39-year-old male who presented 21 years after placement of a ventriculoperitoneal (VP) shunt. He complained of fevers, headaches, dizziness, and urticarial plaques on arms, trunks, and legs and was found to have anemia, low complement levels, elevated serum creatinine, proteinuria, and new onset microhematuria. Blood and urine cultures were negative. Renal biopsy showed features of acute tubulointerstitial nephritis attributed to vancomycin use. Glomeruli showed increased mesangial hypercellularity and segmental endocapillary proliferation. Immunofluorescence showed focal IgM and C3 staining. Electron microscopy revealed small subendothelial electron-dense deposits. Symptoms and renal insufficiency appeared to improve with antibiotic therapy. He was discharged and readmitted 2 months later with similar presentation. CSF grew Propionibacterium acnes and shunt hardware grew coagulase-negative Staphylococcus. He completed an intravenous antibiotic course and was discharged. On 1-month follow-up, skin lesions persisted but he was otherwise asymptomatic. Follow-up labs showed significant improvement. We did a brief systematic review of the literature on shunt nephritis and report our findings on 79 individual cases. In this review, we comment on the presentation, lab findings, pathological features, and management of this rare, potentially fatal, but curable disease entity. |
| format | Article |
| id | doaj-art-dea311aff1924e548545b7c421b39abc |
| institution | Kabale University |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-dea311aff1924e548545b7c421b39abc2025-02-03T07:25:46ZengWileyCase Reports in Nephrology2090-66412090-665X2017-01-01201710.1155/2017/18673491867349Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the LiteratureMichael Babigumira0Benjamin Huang1Sherry Werner2Wajeh Qunibi3Division of Nephrology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX 78229, USASan Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USADivision of Nephrology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX 78229, USADivision of Nephrology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7882, San Antonio, TX 78229, USAWe present an unusual case of shunt nephritis in a 39-year-old male who presented 21 years after placement of a ventriculoperitoneal (VP) shunt. He complained of fevers, headaches, dizziness, and urticarial plaques on arms, trunks, and legs and was found to have anemia, low complement levels, elevated serum creatinine, proteinuria, and new onset microhematuria. Blood and urine cultures were negative. Renal biopsy showed features of acute tubulointerstitial nephritis attributed to vancomycin use. Glomeruli showed increased mesangial hypercellularity and segmental endocapillary proliferation. Immunofluorescence showed focal IgM and C3 staining. Electron microscopy revealed small subendothelial electron-dense deposits. Symptoms and renal insufficiency appeared to improve with antibiotic therapy. He was discharged and readmitted 2 months later with similar presentation. CSF grew Propionibacterium acnes and shunt hardware grew coagulase-negative Staphylococcus. He completed an intravenous antibiotic course and was discharged. On 1-month follow-up, skin lesions persisted but he was otherwise asymptomatic. Follow-up labs showed significant improvement. We did a brief systematic review of the literature on shunt nephritis and report our findings on 79 individual cases. In this review, we comment on the presentation, lab findings, pathological features, and management of this rare, potentially fatal, but curable disease entity.http://dx.doi.org/10.1155/2017/1867349 |
| spellingShingle | Michael Babigumira Benjamin Huang Sherry Werner Wajeh Qunibi Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature Case Reports in Nephrology |
| title | Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature |
| title_full | Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature |
| title_fullStr | Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature |
| title_full_unstemmed | Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature |
| title_short | Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature |
| title_sort | delayed manifestation of shunt nephritis a case report and review of the literature |
| url | http://dx.doi.org/10.1155/2017/1867349 |
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