Glomerulonephritis and nephrotic syndrome in a child with DiGeorge syndrome: Answers
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The findings on eye examination are consistent with Roth spots. In view of her background of congenital cardiac disease with the presence of an indwelling cardiac conduit, the most likely diagnosis is bacterial infective endocarditis with secondary immunologic sequelae including glomerulonephritis.
The next step in evaluation and management is taking repeated sets of blood cultures and commencing empirical antibiotic treatment. In our patient, three repeated sets of blood cultures were positive for Leptotrichia goodfellowii, a rare, slow-growing anaerobe. Antibiotic treatment was adapted as per sensitivities of the bacteria and she received a total of 6 weeks parenteral antibiotic therapy.
The recommended management for her glomerulonephritis with nephrotic syndrome is treating the causative agent with antibiotics, supportive care, in particular controlling hypertension. In rare cases, immunosuppressive therapy has been used for the treatment of non-responding...
KeywordsInfective endocarditis Glomerulonephritis Nephrotic syndrome DiGeorge syndrome
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The authors declare that they have no conflict of interest.
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