Nephrotic syndrome is the most common glomerular disease in children. Most cases are idiopathic and the first episode is rarely related to cytomegalovirus infection, particularly after 3 months of age. We present a 7-month-old infant who developed atypical presentation of nephrotic syndrome secondary to cytomegalovirus infection. The patient was referred to undergo orchipexy due to right-sided undescended testis. Following the surgery, he developed fever, gastroenteritis and renal failure. A few days later, generalized edema and proteinuria were detected. Due to positive test results for cytomegalovirus, ganciclovir was administered. Remission of nephrotic syndrome was obtained within the first two weeks of the treatment. No relapse of nephrotic syndrome was detected during 12 months of follow up. We may conclude that in unexplained infantile nephrotic syndrome, CMV should be considered as one of the possible etiologies.
Keywords: Nephrotic Syndrome; Cytomegalovirus; Infant; Ganciclovir; Edema; Proteinuria; Gastroenteritis.
Lane BM, Cason R, Esezobor CI, Gbadegesin RA. Genetics of Childhood Steroid Sensitive Nephrotic Syndrome: An Update. Front Pediatr. 2019;7:8.
Ha T-S. Genetics of hereditary nephrotic syndrome: a clinical review. Korean journal of pediatrics. 2017;60:55-63.
Stańczyk M, Tkaczyk M. Nephrotic syndrome secondary to cytomegalovirus infection in a infant. Case report. Pediatria i Medycyna Rodzinna. 2015;11:215-9.
Rahman H, Begum A, Jahan S, Muinuddin G, Hossain MM. Congenital nephrotic syndrome, an uncommon presentation of cytomegalovirus infection. Mymensingh Med J. 2008;17:210-3.
Besbas N, Bayrakci US, Kale G, et al. Cytomegalovirus-related congenital nephrotic syndrome with diffuse mesangial sclerosis. Pediatr Nephrol. 2006;21:740-2.
Crough T, Khanna R. Immunobiology of human cytomegalovirus: from bench to bedside. Clin Microbiol Rev. 2009;22:76-98.
Wenderfer SE. Viral-associated glomerulopathies in children. Pediatr Nephrol. 2015;30:1929-38.
Hogan J, Fila M, Baudouin V, Peuchmaur M, Deschênes G, Niel O. Cytomegalovirus infection can mimic genetic nephrotic syndrome: a case report. BMC Nephrology. 2015;16:156.
Soares SF, Donatti TL, Souto FJ. Serological markers of viral, syphilitic and toxoplasmic infection in children and teenagers with nephrotic syndrome: case series from Mato Grosso State, Brazil. Rev Inst Med Trop Sao Paulo. 2014;56:499-504.
Presne C, Cordonnier C, Makdassi R, Pruna A, Fournier A. [Collapsing glomerulopathy and cytomegalovirus, what are the links?]. Presse Med. 2000;29:1815-7.
Grover V, Gaiki MR, DeVita MV, Schwimmer JA. Cytomegalovirus-induced collapsing focal segmental glomerulosclerosis. Clinical Kidney Journal. 2013;6:71-3.
Sue PK, Salazar-Austin NM, McDonald OG, Rishi A, Cornish TC, Arav-Boger R. Cytomegalovirus Enterocolitis in Immunocompetent Young Children: A Report of Two Cases and Review of the Literature. The Pediatric infectious disease journal. 2016;35:573-6.
Shimizu M, Ohta K, Wada H, Sumita R, Yachie A, Koizumi S. Cytomegalovirus-associated protracted diarrhoea in an immunocompetent boy. J Paediatr Child Health. 2006;42:259-62.
Imanzade F, Sayyari A, Tajik P. Cytomegalovirus Colitis in an Immunocompetent Patient: Report of a Case. International Journal of Pediatrics. 2015;3:85-8.
Hsieh MH, Bayne A, Cisek LJ, Jones EA, Roth DR. Bladder injuries during laparoscopic orchiopexy: incidence and lessons learned. J Urol. 2009;182:280-5.