Anti-GBM disease and ANCA during dengue infection

Karlo J. Lizarraga, Jorge Florindez, Pirouz Daftarian, David Andrews, Luis M. Ortega, Jair Munoz Mendoza, Gabriel Contreras, Ali Nayer

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Anti-glomerular basement membrane (GBM) disease is a severe inflammatory renal disorder due to pathogenic autoantibodies directed mainly against the α3 chain of type IV collagen. In ~ 1/4 of patients with anti-GBM disease, antineutrophil cytoplasmic antibodies (ANCA) predominantly with myeloperoxidase (MPO) specificity can be detected. Although the inciting stimuli leading to the development of an immune response against the type IV collagen and neutrophils are unknown, evidence indicates that both genetic and environmental factors play a role. Of note, molecular mimicry between self-antigens and nonself-antigens such as antigenic determinants of microorganisms has been implicated in the pathogenesis of anti-GBM disease and ANCA-associated vasculitis. A mosquito-borne viral illness highly prevalent in the tropics and subtropics, dengue can be complicated by acute renal failure, proteinuria, hematuria and glomerulonephritis. We present a 66-yearold woman who was diagnosed with dengue infection and rapidly progressive glomerulonephritis during an outbreak of dengue in Honduras in the summer of 2013. Renal biopsy revealed severe crescentic glomerulonephritis. Immunofluorescence examination demonstrated strong linear IgG deposition along glomerular capillary walls. Serologic tests demonstrated antibodies against GBM, MPO and platelet glycoproteins. The patient was diagnosed with anti-GBM disease associated with p-ANCA with MPO specificity. Despite heavy immunosuppression and plasmapheresis, IgG titers against dengue virus continued to rise confirming the diagnosis of acute dengue infection. We present the first reported case of anti-GBM disease associated with p-ANCA with MPO specificity during dengue infection. This report calls for a heightened awareness of autoimmunity leading to crescentic glomerulonephritis in patients with dengue infection.

Original languageEnglish
Pages (from-to)104-110
Number of pages7
JournalClinical Nephrology
Volume83
Issue number2
DOIs
StatePublished - 2015

Fingerprint

Anti-Glomerular Basement Membrane Disease
Antineutrophil Cytoplasmic Antibodies
Dengue
Glomerulonephritis
Peroxidase
Infection
Collagen Type IV
Immunoglobulin G
Honduras
Molecular Mimicry
Platelet Membrane Glycoproteins
Kidney
Glomerular Basement Membrane
Dengue Virus
Plasmapheresis
Membrane Glycoproteins
Autoantigens
Serologic Tests
Hematuria
Vasculitis

Keywords

  • ANCA
  • Anti-glomerular basement membrane disease
  • anti-myeloperoxidase antibodies
  • Antineutrophil cytoplasmic antibodies
  • Dengue

ASJC Scopus subject areas

  • Nephrology

Cite this

Anti-GBM disease and ANCA during dengue infection. / Lizarraga, Karlo J.; Florindez, Jorge; Daftarian, Pirouz; Andrews, David; Ortega, Luis M.; Munoz Mendoza, Jair; Contreras, Gabriel; Nayer, Ali.

In: Clinical Nephrology, Vol. 83, No. 2, 2015, p. 104-110.

Research output: Contribution to journalArticle

Lizarraga, Karlo J. ; Florindez, Jorge ; Daftarian, Pirouz ; Andrews, David ; Ortega, Luis M. ; Munoz Mendoza, Jair ; Contreras, Gabriel ; Nayer, Ali. / Anti-GBM disease and ANCA during dengue infection. In: Clinical Nephrology. 2015 ; Vol. 83, No. 2. pp. 104-110.
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