Infection-Related Glomerulonephritis Complicating Entamoeba histolytica Abscess of the Liver

Excerpt

To the Editor: An 8-y-old boy presented with fever and pain in right hypochondrium for 1 wk. There was no diarrhea, dysentery, or vomiting. He weighed 23 kg (-1.26 z); height 137 cm (+0.86 z). He had tender hepatomegaly (liver-span 14 cm). Investigations revealed hemoglobin 12.1 g/dL, leukocytosis (TLC- 19570/mm³; neutrophils 84%), platelet count 2.45 × 10⁹/L, serum creatinine 0.41 mg/dL, albumin 3.63 g/dL, high CRP (9.6 mg/dL) and procalcitonin (26.8 ng/mL), with normal liver-function tests. Abdominal ultrasound revealed multiple hepatic hyperechoic areas, largest 4.6 × 6.6 × 5.9 cm. A pigtail catheter in the liver abscess drained anchovy-sauce pus that was positive for Entamoeba histolytica by PCR. Pus and blood cultures were sterile. IgG Entamoeba histolytica antibodies were positive [48.5 NTU (normal <9 NTU)]. Stool and pus examination showed no trophozoites or cysts. Intravenous metronidazole therapy was initiated. Twelve days later, he developed oliguria with worsening periorbital, pedal, and scrotal edema, ascites and pleural effusions; and stage 2-hypertension (128/96 mm Hg). Urinalysis showed 418 RBC/HPF with 1+ proteinuria. Serum C3 was low (63.17 mg/dL). Serum creatinine was normal (0.23 mg/dL). He was diagnosed as infection-related glomerulonephritis (IRGN). Edema and hypertension resolved with fluid/ salt restriction and furosemide administration. The liver abscesses resolved with metronidazole. Diloxanide was prescribed. Serum C3 normalised at 6 wk (146 mg/dL). …