A case of superantigen-related glomerulonephritis after methicillin-resistant Staphylococcus aureus (MRSA) infection.
A case of superantigen-related glomerulonephritis after methicillin-resistant Staphylococcus aureus (MRSA) infection.
复制标题
耐甲氧西林金黄色葡萄球菌（MRSA）感染后发生超抗原相关性肾小球肾炎一例。
作者：
K. Yoh;M. Kobayashi;A. Hirayama;K. Hirayama;N. Yamaguchi;S. Nagase;A. Koyama
提出了金黄色葡萄球菌肠毒素可能充当细菌超抗原的案例。这名71岁的男子在接触耐甲氧西林金黄色葡萄球菌（MRSA）凝固酶II型肺炎后出现蛋白尿和肾功能障碍。感染发生在复发性肺癌手术后。从芽孢杆菌中检测到葡萄球菌肠毒素 B、C 和 TSST-1。肺炎发病十天后，出现蛋白尿；尿蛋白高达1.8克/天。血清肌酐从 1.0 mg/dl 升高至 3.7 mg/dl。检测到多种免疫反应；血清IgG和IgA水平升高，并观察到T细胞受体Vβ（TCRVβ）的选择性使用。 IL-1β、IL-2、IL-6、IL-8、IL-12 和肿瘤坏死因子 α (TNF α) 的血清水平也升高。通过光学显微镜检查肾活检标本显示轻微至轻度系膜增生性肾小球肾炎。免疫荧光显微镜显示 IgG、IgA 和 C3 主要沿着毛细血管壁沉积。电子显微镜显示电子密集沉积物，主要在上皮下区域，以及肾小球基底膜损伤。当抗生素治疗后肺炎好转时，肾功能也改善，蛋白尿减少。免疫球蛋白水平和 TCRV β 的使用也有所下降。由于葡萄球菌肠毒素充当超抗原，我们认为这是超抗原相关性肾小球肾炎的典型病例。
A case in which the enterotoxins of Staphylococcus aureus may have served as bacterial superantigens is presented. This 71-year-old man developed proteinuria and renal dysfunction after contacting pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA), coagulase type II. The infection occurred after surgery for recurrent lung cancer. Staphylococcus enterotoxins B, C, and TSST-1 were detected from the bacillus. Ten days after the onset of pneumonia, proteinuria was noted; urinary protein was as high as 1.8 g/day. The serum creatinine was elevated from 1.0 mg/dl to 3.7 mg/dl. Several immunological reactions were detected; the serum levels of IgG and IgA were increased, and the selective usage of T-cell receptor V beta (TCRV beta) was observed. Serum levels of IL-1 beta, IL-2, IL-6, IL-8, IL-12, and tumor necrosis factor alpha (TNF alpha) were also elevated. Examination of the renal biopsy specimen by light microscopy showed minor to mild mesangial proliferative glomerulonephritis. Immunofluorescence microscopy demonstrated the deposition of IgG, IgA, and C3, mainly along the capillary walls. Electron microscopy revealed electron dense deposits, mainly in the subepithelial areas, and injury to the glomerular basement membrane. When the pneumonia improved following antibiotic therapy, the renal function also improved, and proteinuria decreased. The levels of immunoglobulins and the usage of TCRV beta also decreased. Because staphylococcus enterotoxins act as superantigens, we believe this to be a typical case of superantigen-related glomerulonephritis.