Treatment of Cytomegalovirus-associated IgA Nephropathy by Deflazacort and Intravenous Immunoglobulin

거대세포바이러스와 연관된 IgA 신병증을 Deflazacort와 정맥 면역글로불린으로 치료한 1례

It has been suspected that various infections, including cytomegalovirus(CMV) infection, are associated with IgA nephropathy. In case of CMV infection, ganciclovir is known to be a treatment of choice for severe CMV infection in general. But ganciclovir has a lot of severe toxicity, so children with normal immunity are seldom treated by ganciclovir when CMV infection is suspected. On the other hand, intravenous immunoglobulin can also be used to treat CMV infection. We report a case of CMV-associated IgA nephrophaty, who was treated with deflazacort and Intravenous immunoglobulin therapy. An 11 years old boy suffered from gross hematuria for 3 days. He had proteinuria, thrombocytopenia(104,000/$mm^3$), antiplatelet antibody(＋), impaired renal function and low serum albumin. His CMV serology was CMV-IgM/IgG(＋/-) and urine CMV-PCR was positive. The renal histological findings revealed IgA nephropathy, WHO class II. His proteinuria persisted despite of deflazacort therapy(2.5 mg/kg/day). Later, intravenous immunoglobulin(1 g/kg) was administered twice. In two years, he showed no gross and microscopic hematuria, and his laboratory findings were also normalized.

거대 세포 바이러스가 IgA 신병증과 연관되었다는 설은 예로부터 논쟁거리가 되어 왔다. 일반적으로 ganciclovir는 거대세포바이러스의 치료제로 알려져 있으나, 부작용 및 독성 때문에 정상 면역을 가진 소아 환자들에게서는 잘 쓰이지 않는다. 본 저자들은 거대세포바이러스와 연관되었다고 생각되는 중증 IgA 신병증 환아를 deflazacort와 정맥 면역글로불린을 병용 투여하여 호전된 경우를 경험하여 보고하는 바이다.