CASE 5

Tibor Nadasdy, MD, PhD
Department of Pathology
Ohio State University, Columbus, OH

CLINICAL HISTORY

            A fifty-one year-old white female presented with generalized symptoms, shortness of breath, nonproductive cough and fever on December 3, 2003.   She was found to have bilateral plural effusions.   She gained twelve pounds in four days and was experiencing bilateral leg swelling. Her blood pressure upon presentation was 162/78 mmHg with a pulse of 103/min.   Her past medical history was remarkable for insulin dependent diabetes mellitus for the last 22 years and hypertension.   Both the diabetes and the hypertension have been under relatively good control.   In June 2003, her serum creatinine was 1.4 and had microalbuminuria. Her medications included Hyzaar, Lasix, Synthroid, Humalog, and Ciprofloxacin (the latter was given recently because of upper respiratory tract and presumed urinary tract infections).

            On presentations, her serum creatinine was 3.4 mg/dl and her BUN was 81 mg/dl. Urinalysis revealed large blood and 3+ proteinuria.   Further laboratory workup revealed low C3 and normal C4 levels.   Her ASO was very high (>3200 IU/ml).   Her ANA, ANCA, and Hepatitis serologies were all negative.   She had an episode of sore throat approximately two to three weeks before the presentation.   Because of the characteristic clinical history, the presumptive diagnosis of poststreptococcal glomerulonephritis was made.  

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