Unusual and missed case of Streptococcal Pharyngitis presenting as membranoproliferative Glomerulonephritis; case report

ABSTRACT

Streptococcal pharyngitis is common in the pediatric age group. Although its treatment is simply achieved by administration of a single dose of benzathine penicillin, oral penicillin for 10 days, or azithromycin for 5 days, it has serious complications such as rheumatic fever [RF] and chorea if left untreated. Treatment of pharyngitis does not prevent glomerulonephritis but prevents the spread of streptococci that can cause an epidemic in glomerulonephritis if they are of the nephritogenic strain. Post Streptococcal Glomerulonephritis [PSGN] is common in school age children and usually has a benign course as more than 95 percent of the cases recover the acute phase and less than 5 percent progress in their course to Rapidly Progressive Glomerulonephritis [RPGN] and ultimately about one percent develop End Stage Renal Failure [ESRF]. Herein, we present a 12-year-old male with a history of untreated streptococcal pharyngitis who first came to our clinic with a history of arthralgia and arthritis, fatigue, hematuria, petechia, purpura, elevated levels of Blood Urea Nitrogen [BUN] and Creatinine [Cr], and low grade fever. Echocardiography revealed endocarditis which was treated. However, renal failure required renal replacement therapy [RRT], and massive proteinuria needed renal biopsy which revealed membrano proliferative glomerulonephritis [MPGN]