Glomerulonephritis triggered by chronical aortic graft infection in a male with Loeys–Dietz syndrome

Abstract

Rationale: Glomerulonephritis triggered by a chronically infected graft is increasingly identified because of widely used implanted device. Removal of the aortic graft and sustained antibiotic therapy is the usual approach to maximize the chance of renal recovery, but as this case shows graft removal is not always possible. Patient concerns: A 35-year-old man with intractable and recurrent fever had acute renal failure in sustained antibiotic therapy. Diagnoses: Renal biopsy suggested crescentic glomerulonephritis. 18 fluorodeoxyglucose/positron emission tomography–computed tomography showed increased metabolic activity at the site of aortic graft, reminding that chronic infection of an implanted graft can lead to severe glomerulonephritis. TGFBR2 c.1133G>T mutation was observed in mutation analysis, which was reported to be associated with Loeys–Dietz syndrome. Interventions: Although infection was properly controlled with appropriate antimicrobial treatment, his renal dysfunction did not improve. A short-term inclusion of low-dose corticosteroid significantly benefit without introducing harm. Outcomes: He partly recovered from renal injury. Lessons: In patients with glomerulonephritis triggered by a long-duration infection, low-dose corticosteroid therapy may be considered when renal dysfunction secondary to nephritis does not improve after appropriate antimicrobial treatment.