Rheumatic fever and poststreptococcal glomerulonephritis: A case report

Abstract

LETTERSthe IgG galactose deficiency seen in rheumatoid arthritis and in a relatively small number of patients with systemic lupus erythematosus (SLE) and Crohn's disease as evidence that changes in carbohydrate are merely a consequence of chronic inflammation.We have set out at some length (2) the arguments for the view that structural changes involving galactose in the Fcy oligosaccharides are restricted to certain diseases. In particular, we have determined the percentage of IgG oligosaccharide chains lacking galactose in over 300 patient sera representing 25 different disease states, and concluded that the galactose glycosylation defect is confined to juvenile and adult rheumatoid arthritis, SLE associated with Sjogren's syndrome, active Crohn's disease, and untreated pulmonary tuberculosis (3). Normal galactose values were obtained not only in SLE uncomplicated by symptoms of Sjogren's disease, but also in primary Sjogren's syndrome, ankylosing spondylitis, psoriatic arthropathy, myositis, scleroderma, leprosy, Klebsiella infection, and other disorders. These findings have recently been confirmed using a novel lectinbinding assay (4). Thus, the data from our laboratories show that this intriguing defect is not a characteristic feature of the chronic inflammatory state in general, but has important associations with certain diseases.The authors' earlier comments concerning decreased lymphocytic galactosyltransferase were prophetic (5).

Haematuria, transient proteinuria, serpiginous-border skin rash, and cardiomegaly in a 10-year-old girl

“…Among these previously reported cases, two were adults [1] and six patients presented with the combination of an initial episode of ARF with carditis along with APSGN [4,7,10,11,12,13], which is similar to the present case; another three reported cases developed APSGN during a recurrent episode of ARF [1,6,8]. The case presented by Kakkera et al [7] had pancarditis with pericardial effusion and this unique feature was also found in our case.…”

“…Imanaka et al [6] presented one case with APSGN and ARF appearing at the same time, which is similar to our case. Erythema marginatum happened in only 1 of the 12 reported cases [8]. The picture of erythema marginatum in our patient was unlike the case reported by Kujala et al [8], who presented with a larger central clear region, while the short duration and evanescent characteristics were similar between the two cases.…”

“…Only 2 of the 12 reported cases had positive throat culture [6,7] and three had the unusual feature of APSGN preceding ARF [9,11,12]. In the other reported cases [1,4,5,7,8,10,13], in which APSGN and ARF occurred together, the ARF was the presenting clinical condition, followed by APSGN. Imanaka et al [6] presented one case with APSGN and ARF appearing at the same time, which is similar to our case.…”

“…Although uncommon, at least 12 cases of concurrent APSGN and ARF have now been reported [1,4,5,6,7,8,9,10,11,12,13]. In fact, the relationship of acute glomerulonephritis (AGN) in patients with acute rheumatic fever has been well described, but its frequency remains unclear.…”

Atypical Clinical Manifestations of Acute Poststreptococcal Glomerulonephritis

“…Although both ARF and APSGN develop following GAS infection, the two diseases have different epidemiology, immunology and bacteriology, and simultaneous occurrence of them in the same patient is rare (Lin et al, 2007). Since Gibney et al first reported a patient with co-occurrence of ARF and histologically proven APSGN (Gibney et al, 1981), seventeen patients with concurrent ARF and APSGN have been reported (Akasheh et al, 1995;Ben-Dov et al, 1985;Castillejos et al, 1985;Imanaka et al, 1995;Kakkera et al, 1998;Kujala et al, 1989;Kula et al, 2003;Kwong et al, 1987;Lin et al, 2003;Mastell et al, 1990;Öner, et al, 1993;Said et al, 1986;Sieck et al, 1992;Sinha et al, 2007).…”