PO202 – Membranoproliferative glomerulonephritis related to Hymenolepis Nana infection: a first case reported

Autori: F. Fiacco (1), I. Umbro (2), A. Cappoli (1), A. Zavatto (1), I. Loconte (1), F. Moccia (1), E. Zanetel (1), G. d’Amati (3), C. Giordano (3), B. Cerbelli (3), S. Golubovic (1), (4), A.P. Mitterhofer (1)
Affiliazioni:  (1) Department of Clinical Medicine (2) Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences (3) Department of Radiological, Oncological and Pathological Sciences (4) Erasmus+ University of Novi Sad, Policlinico Umberto I, Sapienza University of Rome

Membranoproliferative glomerulonephritis (MPGN) accounts for approximately 7-10% of all cases of biopsy-confirmed glomerulonephritis. Traditionally, MPGN has been classified based on electron microscopy. Recently, a new classification of MPGN has been suggested on the basis of immunofluorescence (IF) findings as immune complex (IC) and complement mediated disease. IC-mediated MPGN may be related to autoimmune disease, paraprotein deposition diseases, infection. Among the parasitic forms, schistosomiasis is one of the most frequent causative agent.

Case Report:
We describe the case of a 18 year old Eritrean boy admitted to the Department of Clinical Medicine in November 2016 with leg edema persisting for 15 days. The patient was in Italy for 15 days, traveling with poor hygienic health conditions. His personal medical history was negative except for blood diarrhea occurring upon arrival to Italy. At admission into our Department, the physical examination was positive for leg edema. Laboratory findings showed: anaemia (Hb 10g/dL), severe hypereosinophilia (eosinophils 27%), hypoproteinemia (4.6 gr/dL) and hypoalbuminaemia ( 2 gr/dL), normal levels of C3 and C4, proteinuria 3525 mg/24h and positive sediment (erythrocytes 1076/uL). Serological investigations for major autoimmune diseases were negative. Serum free light chain assay showed κ 37.7 mg/L and λ 49.80 mg/L; Urine free light chain assay showed κ 53.50 mg/L and λ 53.30 mg/L; Serum immunofixation showed slight monoclonal IgM λ peak. HCV and HBV markers, Mantoux test, CMV, EBV, PCR HIV-RNA, all were negative. Parasitological examination of urine and urinocolture were negative while parasitological examination of stool was positive for Hymenolepis Nana (HN). Renal biopsy showed MPGN


Immunofluorescent stained section. Intense, peripheral, glomerular, capillary loop deposition of immunoglobulin G (IgG) with an interrupted linear pattern (original magnification 400x).
Membranoproliferative glomerulonephritis (MPGN). Glomerulus showing lobular accentuation resulting from endocapillary and mesangial hypercellularity associated with thickening of the peripheral capillary walls (PAS; original magnification 200x).
Adult Hymenolepis Nana measures 1-3 cm in length. It is made up of head (scolex), neck and segmental body. The head carries four suckers and a rosetellum armed with one row of hooks. The segments of the body are divided into mature and gravid segments.
Adult Hymenolepis Nana


Eggs of Hymenolepis nana are oval, with a size range of 30 to 50 µm. On the inner membrane are two poles, from which 4-8 polar filaments spread out between the two membranes. The oncosphere has six hooks.
Eggs of Hymenolepis Nana in stool samples of our patients.



Conclusion: HN is the most common cestode infecting humans. The prevalence of intestinal Hymenolepis is quite high among countries where clean water and hygiene are limited although the migration flows have changed it. We reported the first case in literature of MPGN in an Eritrean men with intestinal HN in which we excluded autoimmune diseases, monoclonal gammopathies, viral, bacterial and other common parasitic infections; According to the renal biopsy, normal serum levels of C3, C4 and instrumental investigations we have supposed that MPGN was associated with intestinal parasitosis by HN with an IC mediate pathogenetic mechanism.



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