ABSTRACT
Background: Severe falciparum malaria with renal impairment carries a significant risk of poor outcomes, including death. Previous randomized controlled trials using acetaminophen as adjunctive treatment for malaria-associated renal failure have demonstrated improvements in renal function and kidney injury progression. Case Presentation: A 50-year-old man with severe falciparum malaria presented with hemolytic anemia, oliguric acute kidney injury, nephrotic range proteinuria, and significant architectural changes on renal ultrasound. Treatment with oral acetaminophen 975 mg every 6 hours was based on the randomized controlled trial protocol to salvage his renal function and avoid dialysis. During the acetaminophen course, urine output and cystatin C level improved with only mild, asymptomatic elevations in aminotransferases that were corrected on follow-up. The patient recovered without requiring dialysis. Conclusions: Acetaminophen's potential to mitigate the oxidative damage of hemoproteins suggests its use as a treatment in severe malaria with renal impairment.
ABSTRACT
Acute rheumatic fever (RF) and acute post Streptococcal glomerulonephritis (APSGN) are non-suppurative complications of a Group A Streptococcus (GAS) infection. The concomitant incidence of both complications in a patient is rare because nephritogenic and rheumatogenic strains belong to different serotypes of Group A beta-hemolytic Streptococcus (GABHS). We present a case of a 47-year-old female who had concomitant acute RF and APSGN from a Streptococcus pyogenes infection. It is important to have a high clinical suspicion for the sequela of GABHS infection in the setting of cardiac and renal disease following upper respiratory infection (URI) symptoms even in adults and in geographic locations with the nearly undetectable burden of acute RF because of the importance of secondary prophylaxis with an antibiotic.
