ABSTRACT

Acute post-streptococcal glomerulonephritis (APSGN) and acute rheumatic fever (ARF) are common immune-mediated complications after group A streptococcus (GAS) infection. The causative antigenic epitopes on GAS are different for APSGN and ARF, and their simultaneous occurrence is uncommon. A 12-year-old boy presented with fever and gross haematuria. He had subcutaneous nodules on the dorsum of both feet along with a new holosystolic murmur at the apex, and he developed hypertension and generalised oedema after admission. Investigation confirmed the diagnosis of ARF with APSGN. He received a corticosteroid to control inflammation of both the conditions. His clinical signs gradually improved but he still had rheumatic heart disease. As both diseases can occur in the same patient, treatment should be provided for both conditions.

Abbreviations: APSGN: acute post-streptococcal glomerulonephritis; ARF: acute rheumatic fever; ASO: antistreptolysin O; Cr: serum creatinine; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GAS: group A streptococcus; RBC: red blood cells; RPGN: rapidly progressive glomerulonephritis; S1: first heart sound; S2: second heart sound; TTE: transthoracic echocardiogram.

摘要

急性链球菌感染后肾小球肾炎 (APSGN) 和急性风湿热 (ARF) 是 A 组链球菌 (GAS) 感染后常见的免疫介导并发症。APSGN和ARF的GAS上的致病抗原表位不同，它们同时发生的情况并不常见。一名 12 岁男孩出现发热和肉眼血尿。他的双脚背有皮下结节，心尖部有新的全收缩期杂音，入院后出现高血压和全身水肿。调查证实 ARF 与 APSGN 的诊断。他接受了皮质类固醇来控制这两种情况的炎症。他的临床症状逐渐好转，但仍患有风湿性心脏病。由于这两种疾病都可能发生在同一患者身上，因此应对这两种疾病进行治疗。

缩写： APSGN：急性链球菌感染后肾小球肾炎；ARF：急性风湿热；ASO：抗链球菌溶血素 O；Cr：血清肌酐；CRP：C反应蛋白；ESR：红细胞沉降率；GAS：A组链球菌；RBC：红细胞；RPGN：急进性肾小球肾炎；S1：第一心音；S2：第二心音；TTE：经胸超声心动图。