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Akutes Nierenversagen und seltene schwere Komplikation einer systemischen Steroidtherapie bei einer 73‑Jährigen

Acute renal failure and rare severe complication of systemic steroid treatment in a 73-year-old woman

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Zusammenfassung

Wir berichten über den Fall einer 73-jährigen Patientin bosnischer Herkunft, die mit einem akuten Nierenversagen aufgenommen wurde. Die Nierenbiopsie erbrachte die Diagnose einer infektassoziierten nekrotisierenden sowie extrakapillär proliferativen Glomerulonephritis. Die Patientin berichtete, etwa zwei Wochen zuvor einen fieberhaften Infekt gehabt zu haben. Unsere Diagnostik ergab keinen Hinweis auf einen aktuellen floriden Infekt. Es erfolgte eine systemische Steroidtherapie mit gutem Ansprechen. Sechs Wochen später erfolgte die erneute stationäre Aufnahme der Patientin in einem schwer kranken Zustand. Wir konnten bioptisch in der Magenschleimhaut eine Strongyloides-stercoralis-Infestation nachweisen. Unter der Steroidtherapie hatte sich ein sogenanntes Hyperinfektionssyndrom entwickelt, an dem die Patientin trotz intensivmedizinischer Bemühungen verstarb. Dieser Fall illustriert, dass insbesondere bei Patienten aus Endemiegebieten auch hierzulande an diese Parasitose gedacht werden muss. Wir diskutieren eine wahrscheinliche kausale Verknüpfung mit der Glomerulonephritis und geben eine Übersicht über die Diagnostik, den Krankheitsverlauf und die Therapie dieser Parasitose.

Abstract

This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.

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Author information

Authors and Affiliations

  1. Medizinische Klinik 2/Sektion Nephrologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland

    J. Bramstedt & R. Wrede

  2. Institut für Pathologie, Universitätsklinik Köln, Köln, Deutschland

    J. U. Becker

  3. 1. Medizinische Klinik & Poliklinik (Sektion Infektiologie,& Tropenmedizin) Bernhard-Nocht-Klinik für Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    S. Schmiedel

  4. Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Bremerhaven-Reinkenheide, Bremerhaven, Deutschland

    C. Riemer

  5. Pathologisches Institut Bremerhaven (PIB), Bremerhaven, Deutschland

    W. Back

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  1. J. Bramstedt
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Correspondence to J. Bramstedt.

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Interessenkonflikt

J. Bramstedt, J.U. Becker, R. Wrede, S. Schmiedel, C. Riemer und W. Back geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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H. Haller, Hannover (Schriftleitung)

B. Salzberger, Regensburg

C.C. Sieber, Nürnberg

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Bramstedt, J., Becker, J.U., Wrede, R. et al. Akutes Nierenversagen und seltene schwere Komplikation einer systemischen Steroidtherapie bei einer 73‑Jährigen. Internist 60, 1201–1208 (2019). https://doi.org/10.1007/s00108-019-00677-z

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