A child with painful swollen joints, rash and proteinuria: Answers
- PDF / 170,542 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 18 Downloads / 164 Views
CLINICAL QUIZ
A child with painful swollen joints, rash and proteinuria: Answers Chengdong Kang 1,2 & Juan Huang 1,2,3 & Xiaojing Nie 1,2,3 & Feng Zhao 1,2,3 & Zihua Yu 1,2,3 Received: 24 November 2019 / Revised: 14 February 2020 / Accepted: 28 February 2020 # IPNA 2020
Keywords Hepatitis B virus . Systemic lupus erythematosus . Extrahepatic manifestations . Hepatitis-B-associated glomerulonephritis
Answers 1. Renal pathology of a 9-year-old boy with painful swollen joints, rash, and proteinuria. In Fig. 1 a, b, and c, light microscopy image shows glomerular mesangial cell proliferation; in Fig. 1d–j, immunohistochemical analysis shows deposition of IgG, IgA, IgM, C3d, C4d, C1q, and hepatitis B surface antigen (HBsAg) in the glomeruli, respectively. In Fig. 1 k and l, electron microscopy image shows glomerular mesangial cell proliferation and electron-dense deposits in glomerular mesangial region, respectively (panel a, periodic acid-Schiff stain; panel b, periodic acid-silver metheramineMasson stain; panel c, hematoxylin–eosin stain; original magnifications: a, b, c, d, e, f, g, i, j × 200; k × 4800; l × 10,000). 2. Hepatitis B virus (HBV) infection, hepatitis-B-associated glomerulonephritis 3. Entecavir plus glucocorticoid We prescribed intravenous methylprednisolone (48 mg once a day for 2 weeks and gradually tapered and stopped it after 8 weeks) during the first 10 days after hospitalization. The boy felt a relief of joint pain, but his rash did not
Chengdong Kang and Juan Huang contributed equally to this work. This refers to the article that can be found at https://doi.org/10.1007/ s00467-020-04527-1. * Zihua Yu [email protected] 1
Department of Pediatrics, Dongfang Hospital, 156 Xi Er Huan Bei Road, Fuzhou 350025, Fujian, People’s Republic of China
2
Department of Pediatrics, Fuzhou Clinical Medical College, Fujian Medical University, Fuzhou 350025, Fujian, People’s Republic of China
3
Department of Pediatrics, Affiliated Dongfang Hospital, Xiamen University, Fuzhou 350025, Fujian, People’s Republic of China
disappear. His urine dipstick was still positive for blood (2+) and protein (3+), and his urinary protein quantification was 2.53 g/24 h. As soon as he was diagnosed with HBV infection, we administered oral entecavir (0.5 mg once a day for 3 months) for him. After treating for 8 weeks with methylprednisolone and 3 months with entecavir, the patient’s joint pain resolved and his rash disappeared. Laboratory findings showed that his urinary albumin was negative, his urinary occult blood test was negative, his C4 levels were within normal range, and anti-nuclear antibody (ANA) and antidouble-stranded DNA (anti-ds DNA) antibodies were negative. At follow-up 1 year later, the patient had neither rash nor joint pain. Laboratory findings showed that his urinary albumin was negative, his urinary occult blood test was negative, his C4 levels were normal, but ANA and anti-ds DNA antibodies were positive. His serum HBV viral load was 1.12 × 108 copies/ml (Table 1).
Discussion HBV infection leads to liver
Data Loading...
