A 20 year old African American Male presented with 1 day history of bilateral throbbing headache , nausea , vomiting .On further questioning, he reported experiencing flu like symptoms 2-3 weeks ago with fever, sore throat and fatigue that lasted for around 5 days. He was found to have a blood pressure of 210/110 at presentation and laboratory examination was significant for BUN of 24, creatinine of 5.5 and proteinuria of 13.4 grams in 24 hours urine collection . Renal biopsy was then done and it was consistent with a diagnosis of Focal Segmental Glomerulosclerosis-collapsing variant . A detailed work up for HIV, CMV, Parvo Virus B19 and connective tissue disorder was negative. IgM for EBV was positive at a level of 1.49 and IgG was negative suggesting acute infection with EBV. Prominent adenoid tonsils were found on CT Head. A diagnosis of acute EBV infection related collapsing glomerulopathy was made based on the temporal relation with the infection, kidney biopsy finding and presence of IgM antibodies in the absence of IgG antibodies against EBV.
The association between acute infection with EBV and renal disease is well known with some studies showing renal involvement in as high as 15% of the cases of acute EBV infection. The renal manifestations of EBV infections are mostly limited to mesangial proliferative glomerulonephritis, crescentric glomerulonephritis, minimal change disease, membranous nephropathy and interstitial nephritis. Although the association between EBV and collapsing FSGS has been mentioned in literature, the association has been too weak to establish a casual relationship.
Focal Segmental Glomerulo-Sclerosis (FSGS) is a leading cause of primary nephrotic syndrome and one of the most common causes behind end stage renal disease. Collapsing variant of FSGS is now a well defined entity, the association of which to HIV infection, heroin abuse,( parvo virus B19) and pamidronate use is well known. Despite being mentioned as a cause behind collapsing variant of FSGS, the association between EBV and FSGS has been weak. We report one such rare case of collapsing glomerulopathy with a fairly acceptable casual relation with acute infection with EBV and emphasize that collapsing FSGS secondary to EBV should be suspected in clinically relevant cases.