Rationale: Pneumocystis pneumonia (PCP) is an opportunistic fungal infection that occurs in people with impaired or suppressed immunity such as patients with human immunodeficiency virus or organ transplant. However, the incidence and characteristics of PCP in the population with long-term hemodialysis is poorly described in the literature. Patient concerns: We present a case of a 50-year-old female patient being transferred to our hospital in February 2022 with a 20-day history of cough and tight breath. She received amoxicillin and cephalosporin anti-infection treatment successively in local hospital but no significant improvement in symptoms. She had a 2-year history of hemodialysis and no relevant transplantation and human immunodeficiency virus infection. She was diagnosed as ANCA associated vasculitis (AAV) and given oral prednisone acetate (20 mg/day) and methotrexate (2.5 mg/week) half a year ago. Diagnoses: Based on the patient’s medical history, Lung computerized tomography image, the Next generation sequencing report, the patient was diagnosed with renal failure, anti-neutrophil cytoplasmic antibody associated vasculitis, and Pneumocystis pneumonia. Interventions: The dosage of immunosuppressant was reduced due to leucocyte dripping and fever, and antibiotic and antifungal treatment were also given. The patient’s lung condition was getting worse and noninvasive ventilator was required to maintain blood oxygen. Blood filtration is used to remove toxins. Ganciclovir and trimethoprim-sulfamethoxazole was used based on the next generation sequencing report. Outcomes: The patient died of respiratory failure. Lessons: The risk of PCP in hemodialysis patients may be higher than that in ordinary population, and the prognosis of patients with immunosuppression may be worse. Dynamic assessment of vasculitis activity is necessary for hemodialysis patients with AAV because infections may obscure lung symptoms of AAV. It is not recommended that hemodialysis patients with long-term immunosuppression should reduce or stop the dosage of immunosuppressive drugs during the treatment because it may aggravate the condition of PCP. There is still no clear conclusion on whether hemodialysis patients need preventive medicine, but the identification of risk factors and early diagnosis and treatment are important for the prognosis of PCP on hemodialysis population.
Background: Primary membranous nephropathy (PMN) refers to an immune complex-mediated cause of the nephrotic syndrome, which is one of the leading causes of end-stage renal disease worldwide and imposes a heavy burden on patients with PMN and the medical insurance system. The risk of complications and unsatisfied efficacy limit the use of traditional diagnostic methods in some patients. Thus discovery of novel diagnostic biomarkers is needed. The aim of the present study was to identify potential diagnostic biomarkers for PMN and revealing the significance of immune cell infiltration for its pathogenesis. Methods: Three gene expression profiles (GSE108109, GSE104948, GSE47185) from samples from patients with PMN and controls were obtained from Gene Expression Omnibus (GEO) database as a training set, and GSE99340 was downloaded as a validation set. Differentially expressed genes (DEGs) were identified using the training set, and functional correlation analyses were conducted by R software. Three machine-learning strategies were performed to identify potential diagnostic biomarkers for PMN and receiver operating characteristic (ROC) curves was used for both training sets and the validation set to evaluate the diagnostic efficacy of these biomarkers. In addition, cell-type identification by estimating relative subsets of RNA transcript (CIBERSORT) bioinformatics algorithm was employed to assess the immune cell infiltration in PMN and the relationships between the diagnostic biomarkers and infiltrating immune cells were characterized. Results: Eighty-six DEGs received the recognition. CCAAT/enhancer-binding protein delta (CEBPD) and Myozenin 2 (MYOZ2) were identified as biomarker genes for the diagnosis of PMN. As indicated from the immune cell infiltration analysis, neutrophils, memory B cells and monocytes may be involved in the development of PMN. Additionally, both CEBPD and MYOZ2 might correlate with immune cells in diverse degrees. Conclusions: CEBPD and MYOZ2 are potential diagnostic biomarkers of PMN, and the immune cell infiltration plays important roles in the pathogenesis of this disease.
Rationale: The causal relationship between anti-glomerular basement membrane (anti-GBM) disease and immunoglobulin A (IgA) nephropathy is still unclear and cases of concurrent anti-GBM disease and IgA nephropathy are very rare, especially with a good prognosis and long-term follow-up. Here, we report a case of concurrent anti-GBM disease and IgA nephropathy. By using corticosteroids and cyclophosphamide in combination with plasmapheresis, the patient achieved a very good prognosis with complete normalization of renal function and complete disappearance of hematuria and proteinuria at the subsequent follow-up. To our knowledge, no previous case with such a long follow-up and such a good prognosis have been reported. Patient concerns: This case report describes a 26-year-old Chinese woman who presented with fever as the initial symptom, followed by dysmorphic hematuria, overt proteinuria and rapidly worsening renal function. Before admission, the patient received symptomatic supportive treatment such as intravenous albumin infusion, improvement of circulation, but the symptoms were not significantly improved. Diagnosis: Per the results of kidney biopsy, the patient was diagnosed with crescentic glomerulonephritis and anti-GBM disease with IgA nephropathy. Interventions: The key to obtain a good prognosis was the early application of corticosteroids and cyclophosphamide in combination with plasmapheresis to make the anti-GBM antibody turn negative quickly. Outcomes: After 2 weeks of therapy, the patients’ anti-GBM antibody turned negative and serum creatinine improved to a normal range. After 10 months, the patient’s proteinuria level reached complete remission. After 12 months, the patient’s hematuria had disappeared completely. Lessons: This case provides experience in the treatment of concurrent anti-GBM disease and IgA nephropathy and highlights the importance of early application of plasmapheresis and immunosuppressive therapy to obtain a good prognosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.