HYPERSENSITIVITY VASCULITIS WITH ACUTE NEPHRITIC SYNDROME DURING SEVERE CO-INFECTION

Abstract

Many pathogenic microorganisms can induce a complex series of immunologic, endothelial-cell and cascades activation and dysfunctions. These events induce the development of hypersensitivity vasculitis. Case report: We report the case of 13 years-old girl with hypersensitivity vasculitis, which developed during the course of a mixed infection with beta-hemolytic streptococcus and EBV infection. A month before hospitalization the girl had two episodes of purulent tonsillitis for which she received antibiotic treatment. After a week period without complains she is presented again with high temperature, chills, photophobia, insomnia, muscle pains, maculopapular rash that involves the body and suppurative tonsillitis. In the next days haemorrhagic macules, papules and patches appeared on the face, neck, legs, billateral conjunctival ecchymosis, epistaxis and tonsillar hemorrhage. The medical condition manifests with deteriorated condition of the child, septic fever, generalized lymphadenopathy and hepatosplenomegaly. The clinical presentation is enriched with symptoms of acute nephritic syndrome. There is a history of several tick bites and contact with dogs, without clinical evidence for Erythema migrans. Conclusions: This case is a demonstration of a severe clinical course of Hypersensitivity vasculitis with acute nephritic syndrome as a result of the identified co-infection beta-hemolytic streptococcus and EBV infection. The clinical course is due to the development of complicated pathogenic and immunologic mechanisms. The positive serology for B. Burgdorferi without the presentation of the specific symptoms of Lyme disease is due to cross reaction.  Long-term clinical and laboratory follow-up showed complete recovery.