Lyme disease associated with kidney problems

Case #1

A 57-year-old woman presented to the hospital with shortness of breath. Two weeks earlier, she experienced nausea, fatigue, headache and myalgias, before developing dyspnea on moderate exertion, the authors state. She also reportedly had a rash on her shoulder.

She was diagnosed with Lyme disease and initially treated with doxycycline. Concerned that she may have disseminated Lyme disease, the woman was later switched to intravenous ceftriaxone.

“Findings included global hypercellularity, mesangial expansion and subendothelial deposits consistent with an immune complex-mediated membranoproliferative glomerulonephritis,” the authors state.

The patient was treated successfully with steroids and antibiotics.

The authors suggest, “the temporal relationship, multisystem presentation, characteristic histology and response to antibiotics and steroids are consistent with a B. burgdorferi induced, immune complex-mediated, glomerulopathy.”

Case #2

A 40-year-old man from Massachusetts presented to the emergency department with gross hematuria (blood in the urine). One week prior, he had been bitten by a tick and subsequently developed myalgias, sore throat, headache and fever.

“The urine sediment revealed dysmorphic red cells and red cell casts … a renal biopsy revealed focal proliferation, one cellular crescent and mesangial IgA reactivity, consistent with IgA nephropathy,” the authors state.

“The temporal relationship to Lyme infection (and subsequent quiescence with treatment) raises the possibility that the acute flare was caused by an intense activation of the immune response.”

The patient began treatment with high dose oral steroids.

During this period, he developed a macular rash in his armpit.

Testing for Lyme disease was positive and the man was prescribed oral doxycycline.

This case “raises the possibility that Lyme infection can lead to activation of a previously quiescent glomerular condition,” the authors state.

Authors Conclude:

• “Lyme-associated glomerular disease should be considered in patients from endemic areas presenting with nephritis.”