Chronic catheter-related bacteremia of Pseudomonas stutzeri etiology as the cause of membranous-proliferative glomerulonephritis (MPGN) - a case report.

Secondary membranous - proliferative glomerulonephritis most often develops in the course of viral infections (HCV, HBV), autoimmune diseases, paraproteinemia, and also in the course of chronic bacterial infections. Infections with Pseudomonas stutzeri (P. stutzeri) are extremely rare and usually mildly symptomatic. The natural habitat of this bacterium is soil and water. Nevertheless, in the case of P. stutzeri infection, especially in patients frequently hospitalized or receiving immunosuppressive medications, environmental contamination in healthcare facilities should be taken into account when looking for the source of the infection.A 60-year-old man with a previous history of nicotinism and arterial hypertension with a vascular port in the vena cava superior (VCS) after treatment for bladder cancer (stage G2/G3) several years ago was described. The patient underwent the TURBT procedure, and then received intravesical infusions with BCG for 3 years, followed by complications in the form of severe dysuria and lower abdominal pain. Due to severe nausea and the inability to take analgesics orally, the patient was ordered to insert a vascular port into the VCS in order to continue the analgesic and anti - inflammatory therapy. Several years later, after the onset of massive edema of lower limbs, the patient was subjected to a 24-hour urine collection, in which proteinuria amounted to approx. 13 g/day, followed by a diagnostic kidney biopsy. Histopathological examination described membranoproliferative glomerulonephritis (MPGN). Other renal parameters were also abnormal, i.e. serum creatinine concentration was 1.9 mg/ dl and serum urea concentration was 116 mg/dl. Immunosuppressive treatment was initiated. Patient received methylprednisolone intravenously followed by prednisone orally and cyclosporine orally. During the initial period of immunosuppressive therapy, the serum levels of cyclosporine were insufficient (starting from 26.34 ng/ml), which resulted in increasing its dose, ultimately reaching 175 mg/day. After several months of therapy, the patient was hospitalized again, due to infection of the respiratory tract that had lasted for several weeks and was not amenable to antibiotic therapy. Deterioration of renal parameters and increased inflammatory markers suggested diagnosis of catheter - related sepsis. P. stutzeri was grown from the material collected from the catheter and the patient's blood. Appropriate antibiotic therapy was initiated and after the patient's condition improved, cyclosporine therapy was restarted, which was discontinued after the diagnosis of bacteremia. Rapid remission was achieved, allowing the discontinuation of immunosuppressive drugs.Chronic, asymptomatic infection with a rare pathogen, like Pseudomonas stutzeri, was probably the cause of the glomerulonephritis. After removal of the port and antibiotic therapy, disease remission was achieved.