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Case report
Concomitant nephrotic syndrome and tubulointerstitial nephritis in a child with Epstein-Barr virus mononucleosis
  1. Ratna Acharya1,
  2. Xu Zeng2 and
  3. Kiran Upadhyay3
  1. 1Pediatrics, University of Florida, Gainesville, Florida, USA
  2. 2NephroPathology, University of Florida College of Medicine, Gainesville, Florida, USA
  3. 3Pediatrics, Nephrology, University of Florida Health, Gainesville, Florida, USA
  1. Correspondence to Dr Kiran Upadhyay; dockiranbp{at}yahoo.com

Abstract

Acute kidney injury (AKI) and nephrotic syndrome (NS) are uncommon manifestations of Epstein-Barr virus (EBV) mononucleosis. We report a 4-year-old boy with Infectious mononucleosis (IM) who presented with dialysis-requiring AKI and NS. Renal biopsy showed severe acute tubular necrosis, mild chronic interstitial nephritis and focal podocyte foot processes effacement. EBV early RNA was not detected in the renal tissue. However, immunophenotyping of peripheral lymphocytes showed increased cytotoxic T cell activity and increased memory B cells. Treatment with steroid led to rapid resolution of NS within 3 weeks. Renal function stabilised. EBV viral capsid antigen (VCA) IgM remained elevated until 4 months before starting to decline when VCA IgG and nuclear antigen started appearing. B lymphocytes are the predominant target cells in EBV infection and additionally may also act as antigen presenting cells to T lymphocytes, thereby eliciting the strong immune response and leading to podocyte and tubulointerstitial injury.

  • infections
  • paediatrics (drugs and medicines)
  • nephrotic syndrome
  • acute renal failure
  • dialysis

https://doi.org/10.1136/bcr-2020-240108

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    Footnotes

    • Contributors RA, XZ and KU: collected data, drafted the initial manuscript, and reviewed and revised the manuscript; KU: collected data, conceptualised the study, drafted the initial manuscript and critically reviewed and revised the manuscript; all authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.