莱姆病合并IgA肾病1例

A Case of Lyme Disease with IgA Nephropathy

患者女,49岁,昆虫叮咬后左颈部淋巴结肿大10 d,游走性红斑伴发热6 d。皮肤科情况:双侧颈部、腹股沟可触及多发肿大淋巴结,躯干、四肢多发环形红斑,直径1～4 cm不等。皮损组织病理示:真皮浅层水肿,血管周围灶状淋巴细胞浸润,散在嗜酸性粒细胞及浆细胞。莱姆病螺旋体IgG抗体1∶80,IgM抗体1∶200。予头孢曲松钠输液治疗10 d后皮疹消退。入院2周后尿中泡沫大量增多,24 h尿蛋白7.11 g/d。肾穿活检:局灶系膜增生,伴新月体形成。免疫荧光示:系膜区弥漫IgA、C_3颗粒状沉积。诊断:莱姆病合并IgA肾病。

A 40-year-old female presented with left cervical lymphadenopathy for 10 days,and fever with erythema migrans for 6 days after bitten by an insect. Physical examination showed bilateral cervical and inguinal lymphadenopathy,erythema migrans with the diameter of 1~4 cm on her trunk and limbs. Biopsy of the lesion showed lymphocytes infiltration in upper dermis with scattered eosinophils and plasma cells. IgG and IgM antibodies to Borrelia burgdorferi were 1∶80 and 1∶200 respectively. The lesions faded away after 10 days of intravenous ceftriaxone sodium treatment. On the 14th day of admission,the foam in urine increased dramatically.The 24 h urine protein was 7.11 g/d.Renal biopsy showed focal mesangial proliferation with crescent. Immunofluorescence study showed diffuse granular deposits of IgA and C3 in the mesangium. The diagnosis of Lyme disease with IgA nephropathy was made.