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Case Reports
. 2025 Jan-Mar;47(1):e20240104.
doi: 10.1590/2175-8239-JBN-2024-0104en.

Collapsing glomerulopathy associated with parvovirus B19 and systemic lupus erythematosus in a patient with APOL1 high-risk variant for nephropathy

[Article in English, Portuguese]
Thaíza Passaglia Bernardes  1 , Thalita Alvarenga Ferradosa Paula  1 , Gabriel Teixeira Montezuma Sales  1 , Patrícia Varela Calais  2 , Renato Demarchi Foresto  3 , Luiz Antonio Moura  1   3 , Marcelino de Souza Durão Junior  1 , João Bosco Pesquero  2 , Gianna Mastroianni Kirsztajn  1
Affiliations
Case Reports

Collapsing glomerulopathy associated with parvovirus B19 and systemic lupus erythematosus in a patient with APOL1 high-risk variant for nephropathy

[Article in English, Portuguese]
Thaíza Passaglia Bernardes et al. J Bras Nefrol. 2025 Jan-Mar.

Abstract
in English, Portuguese

Collapsing glomerulopathy (CG) has a severe course typically associated with viral infections, especially HIV and parvovirus B19, systemic lupus erythematosus (SLE), among other etiologies. A 35-year-old woman with recent use of a JAK inhibitor due to rheumatoid arthritis presented with a 2-week history of fever, cervical adenopathy, and facial erythema. After admission, anemia, hypoalbuminemia, proteinuria, and severe acute kidney injury were noted. SLE was diagnosed and parvovirus B19 DNA was detected in serum samples. Kidney biopsy showed CG without any typical features of lupus nephritis. The patient was treated with prednisone and presented marked improvement of anemia and kidney function after a few weeks. In this case, the patient with SLE presented CG possibly caused by parvovirus B19 infection associated with homozygous apolipoprotein 1 (APOL1) G1 genotype, which has been described as a determinant risk factor for this glomerulopathy. It is not clear whether SLE had a causal relationship with glomerular disease or was a concurrent cause. Treatment can be challenging in such a context, as no antiviral drug is efficient and immunosuppression has no discernable benefit, although steroid use was efficient in treating renal manifestations in this case.

Resumo: A glomerulopatia colapsante (GC) apresenta um curso grave, tipicamente associado a infecções virais, especialmente HIV e parvovírus B19, lúpus eritematoso sistêmico (LES), entre outras etiologias. Uma mulher de 35 anos, com uso recente de um inibidor de JAK devido à artrite reumatoide, apresentou histórico de duas semanas de febre, adenopatia cervical e eritema facial. Após a admissão, observou-se anemia, hipoalbuminemia, proteinúria e injúria renal aguda grave. Foi diagnosticado LES e o DNA do parvovírus B19 foi detectado em amostras de soro. A biópsia renal revelou GC sem quaisquer características típicas de nefrite lúpica. A paciente foi tratada com prednisona e apresentou melhora acentuada da anemia e da função renal após algumas semanas. Neste caso, a paciente com LES apresentou GC possivelmente causada por infecção por parvovírus B19 associada ao genótipo homozigoto G1 da apolipoproteína 1 (APOL1), que tem sido descrito como um fator de risco determinante para essa glomerulopatia. Não está claro se o LES teve uma relação causal com a doença glomerular ou se foi uma causa concomitante. O tratamento pode ser desafiador nesse contexto, uma vez que nenhum medicamento antiviral é eficaz e a imunossupressão não apresenta benefícios perceptíveis, embora o uso de esteroides tenha sido eficaz no tratamento das manifestações renais nesse caso.

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Conflict of interest statement

Conflicts of Interest: The authors declare that they have no conflict of interest related to the publication of this manuscript.

Figures

Figure 1
Figure 1. Light microscopy (x 400) – Jones staining – showing a glomerulus with segmental collapsed capillary walls surrounded by hypertrophic/degenerative podocytes, with hyaline granules next to a dilated tubule filled with a cylinder.
Figure 2
Figure 2. Transmission electron microscopy (x 8000) showing capillary walls with retraction and tortuosity. Electron dense deposits within the mesangium (lower arrow) and a few subepithelial deposits in the capillary wall (upper arrow).
Figura 1
Figura 1. Microscopia óptica (x 400) - coloração de Jones - mostrando glomérulo com paredes capilares segmentares colapsadas circundadas por podócitos hipertróficos/degenerativos, com grânulos hialinos ao lado de um túbulo dilatado preenchido por um cilindro.
Figura 2
Figura 2. Microscopia eletrônica de transmissão (x 8000) mostrando paredes capilares com retração e tortuosidade. Depósitos elétron-densos no mesângio (seta inferior) e alguns depósitos subepiteliais na parede capilar (seta superior).
See this image and copyright information in PMC

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