Acute Glomerulonephritis Following Systemic Scabies in Two Brothers

Abstract

Scabies is a parasitic infestation of the skin with high prevalence in crowded spaces. In some instances, scabies becomes the underlying factor for complicated skin-borne opportunistic pathogens infections in both children and adults. Geographic area and socio-economic factors are determinants of the endemic pattern of this disease. Currently, the treatment of scabies has been under special attention. A combination of oral therapy with Ivermectin and sulfur-based ointments are the gold standard. However, caution is required in patients with kidney impairment. The renal involvement in children with scabies is mainly caused by acute glomerulonephritis. The severity of the nephritic syndrome can lead to other complications. Also, Ivermectin possesses a nephrotoxic effect. Severe hypertension can lead to neurological complications. The aim of our case report is to present two unusual complications in brothers with scabies. We report the cases of two brothers with scabies who presented with severe skin infection that developed acute post infectious glomerulonephritis (APIGN). In addition, one of the brothers presented with posterior reversible encephalopathy syndrome (PRES). The other one developed acute tubule-interstitial acute kidney injury following Ivermectin administration. The evolution of skin lesions was favorable, and kidney function returned to normal in both brothers.

Keywords: APIGN; PRES; children; scabies.

Figure 1

Skin lesions at admission. Legend: In this Figure above, the typical skin lesions of scabies infestation are shown. In (A,C) are the lesions extents in the upper and lower limbs. In (B) is shown the severity of the skin lesions in the buttocks area.

Figure 2

Kidney biopsy—optic microscopy with HE staining. Legend: Haematoxylin eosinophil (HE) stain, magnified by 20× (A,B) and 40×, respectively (C). Hypercellular glomeruli with numerous neutrophils inside the capillary loops (blue arrow), and minimal mesangial expansion (green arrow).

Figure 3

Kidney biopsy—immunofluorescence staining. Legend: Immunofluorescence staining with 20× magnification. Coarse granular deposition of C3c deposits along the glomerular basement membrane. C3c-FITC stain.

Figure 4

The serum creatinine levels evolution. Legend: The first dose of Ivermectin was administered in the first day of hospital stay—blue line. One should notice the descending trend in serum creatinine (eGFR = 72.55 mL/min/1.73 m²). The protocol in scabies requires two dose administrations. Prior to kidney biopsy, the second dose of Ivermectin was administered—dotted blue line. There was an accelerated kidney function decline in the first 48 h after administration of a nephrotoxic medication. After reaching the maximum serum creatinine level of 155 µmol/L, Prednisone therapy was initiated. The baseline serum creatinine was recorded at 6 weeks after the acute glomerulonephritis episode developed. There was a slow recovery of kidney function.

Figure 5

Serum creatinine dynamics in brother A. Legend: Ivermectin was administered in two doses, 1 week apart, from the first day of admission. The serum creatinine levels were on the descendent trend, with some variations during hospital stay, without, however, reaching the definition of acute kidney injury afterwards.

Figure 6

Magnetic resonance imaging with contrast. Legend: Brain MRI performed on the second day after onset of symptoms detected increased signal on Flair- and T2-weighted imaging in the subcortical and cortical regions of the parietal-occipital areas (axial FLAIR images (A,C,D)). Also, the superior frontal area showed the same changes (sagittal view (B)), pointed out by the blue arrows. However, normal diffusion without hemorrhages were identified (A). The diagnosis of PRES was made after imaging was performed.