Secondary membranous - proliferative
glomerulonephritis most often develops in the course of
viral infections (HCV, HBV),
autoimmune diseases,
paraproteinemia, and also in the course of chronic
bacterial infections.
Infections with Pseudomonas stutzeri (P. stutzeri) are extremely rare and usually mildly symptomatic. The natural habitat of this bacterium is soil and water. Nevertheless, in the case of P. stutzeri
infection, especially in patients frequently hospitalized or receiving immunosuppressive medications, environmental contamination in healthcare facilities should be taken into account when looking for the source of the
infection.
A CASE REPORT: A 60-year-old man with a previous history of nicotinism and arterial
hypertension with a vascular port in the vena cava superior (VCS)
after treatment for
bladder cancer (stage G2/G3) several years ago was described. The patient underwent the TURBT procedure, and then received intravesical infusions with BCG for 3 years, followed by complications in the form of severe
dysuria and lower
abdominal pain. Due to severe
nausea and the inability to take
analgesics orally, the patient was ordered to insert a vascular port into the VCS in order to continue the
analgesic and anti - inflammatory
therapy. Several years later, after the onset of massive
edema of lower limbs, the patient was subjected to a 24-hour urine collection, in which
proteinuria amounted to approx. 13 g/day, followed by a diagnostic kidney biopsy. Histopathological examination described
membranoproliferative glomerulonephritis (MPGN). Other renal parameters were also abnormal, i.e. serum
creatinine concentration was 1.9 mg/ dl and serum
urea concentration was 116 mg/dl. Immunosuppressive treatment was initiated. Patient received
methylprednisolone intravenously followed by
prednisone orally and
cyclosporine orally. During the initial period of immunosuppressive therapy, the serum levels of
cyclosporine were insufficient (starting from 26.34 ng/ml), which resulted in increasing its dose, ultimately reaching 175 mg/day. After several months of
therapy, the patient was hospitalized again, due to
infection of the respiratory tract that had lasted for several weeks and was not amenable to
antibiotic therapy. Deterioration of renal parameters and increased inflammatory markers suggested diagnosis of
catheter - related
sepsis. P. stutzeri was grown from the material collected from the
catheter and the patient's blood. Appropriate
antibiotic therapy was initiated and after the patient's condition improved,
cyclosporine therapy was restarted, which was discontinued after the diagnosis of
bacteremia. Rapid remission was achieved, allowing the discontinuation of immunosuppressive drugs.
CONCLUSIONS: