Simultaneous occurrence of nephrotic syndrome, chronic granulomatous disease and Nocardia brain abscess in a patient

Abstract

A 13-year old girl was hospitalized because of generalized edema, fever and signs and symptoms of meningitis. In the history she had frequently abscess formation in extremities, which necessitated antibiotic therapy. Lumber puncture revealed turbid liquor with 2880/mm3 WBC (Poly 73%, lymph 23%), protein 20 mg% and sugar 29 mg% (Blood sugar 100 mg%). Urinalysis showed proteinuria 3+. The usual meningitis therapy was unsuccessful. Brain CT-scan was compatible with a brain abscess in occipital region. The abscess was evacuated which contained norcardia. An immunologic evaluation of the patient showed disturbance in NBT test confirming the presence of chronic granulomatous disease. After successful treatment of nocardiosis with abscess evacuation and antibiotics the nephritic syndrome subsided without and special therapy and the patient could be discharged in good health condition. Three months later a relapse of the nephritic syndrome was successfully treated with corticosteroids