Minimal change nephrotic syndrome in a patient with strongyloidiasis

Abstract

Strongyloidiasis, a chronic infection caused by the intestinal parasite Strongyloides stercoralis, is prevalent in the Nansei Islands of Japan. Here, we report our findings on a case of strongyloidiasis complicated with steroid-resistant minimal change nephrotic syndrome in a 69-year-old male resident of Fukuoka Prefecture who had lived in Yakushima, one of the Nansei Islands, until age 15. In October 2006, he developed proteinuria and edema, and was diagnosed with minimal change nephrotic syndrome on the basis of the renal biopsy findings. Following treatment with prednisolone, the level of proteinuria decreased to 0.29 g/day by day 35. However, 5 days later (day 40), the patient developed persistent watery diarrhea and vomiting, leading to dehydration and malnutrition. Pneumonia and bacterial meningitis subsequently developed (day 146); filarial (infectious-type) and rhabditiform (noninfectious-type) S. stercoralis larvae were detected for the first time in the patient's sputum, gastric juice, feces, and urine. Although treatment with ivermectin was started immediately and the parasitosis responded to the treatment, the patient died of sepsis. Consequently, although strongyloidiasis is a rare infection except in endemic regions, it is essential to consider the possibility of this disease and begin treatment early for patients who have lived in endemic areas and who complain of unexplained diarrhea during steroid-induced or other immunosuppression.

“Surprise” in the evolution of chronic membranoproliferative glomerulonephritis associated with severe strongyloidiasis under corticotherapy: “hygienic paradox”?

“…It should be mentioned that seven of these cases died despite specific antiparasitic therapy. 6 An association of strongyloidiasis with membranoproliferative glomerulonephritis, similar to our case, has been described in the literature by Sathe and Madiwale. 14 Strongyloidiasis is frequently associated to glomerulonephritis in children, as described in Cambodgia, where this parasitosis is endemic.…”

“…One of these is represented by the association of a parasitosis, such as strongyloidiasis, with chronic glomerulonephritis treated by corticotherapy. [3][4][5][6] In this case, corticotherapy perturbs the relationship between immune mechanisms in glomerulonephritis and parasitic disease (strongyloidiasis). This relationship is rarely described in the literature when the two diseases are associated or causally related.…”

“…6 The association of strongyloidiasis with glomerular nephropathy has been reported in the literature. 6 This association raises the following questions: Is strongyloidiasis the cause of the glomerular nephropathy? Does this infection aggravate a pre-existing glomerulonephritis?…”

Strongyloides stercoralis infection in transplanted patients

“…Kidney disease, including nephrotic syndrome due to minimal change disease [13,14] and acute interstitial nephritis have been reported in association with strongyloidiasis. In one case, minimal change disease was proven by kidney biopsy and the disease remitted once the infection was treated with Ivermectin [15].…”

Comment about nephrotic syndrome in association with strongyloidiasis

“…We read with interest the recent work: ''Minimal change nephrotic syndrome in a patient with strongyloidiasis'' [1] where Dr. Miyzaki and colleagues quote 15 reported cases of nephropathy associated with Strongyloides stercoralis (Ss). We would like to add to this list another case that we reported in 2007 regarding this topic [2].…”