Abstract
BackgroundBalantidium coli, a parasitic unicellular ciliate, often causes asymptomatic balantidiasis of the colon, but extraintestinal disease may occur rarely in immunosuppressed individuals. Renal balantidiasis associated with systemic lupus erythematosus has not been reported before.Case presentationWe present a case of a 48-year-old Thai woman who presented with nephrotic syndrome due to systemic lupus erythematosus–related nephritis. Initially, few B. coli cysts were found in urine sediment, but these increased substantially following treatment with prednisolone. She made an uneventful recovery with 10 days of oral tetracycline therapy. No B. coli cysts were found in her stool.ConclusionThe route of infection in our patient was unclear but is likely to have been orofecal. Neither her infection nor its treatment caused a deterioration in her renal function.
Highlights
BackgroundBalantidium coli (Neobalantidium coli) is a large, unicellular, ciliated parasite that infects mainly the gastrointestinal tract of humans and several mammals, such as wild pigs, cattle, sheep, and goats [1]
Balantidium coli, a parasitic unicellular ciliate, often causes asymptomatic balantidiasis of the colon, but extraintestinal disease may occur rarely in immunosuppressed individuals
The cyst releases trophozoites in the duodenum, which mature and migrate to the colon, where they replicate by transverse binary fission and, less frequently, by conjugation
Summary
Balantidium coli (Neobalantidium coli) is a large, unicellular, ciliated parasite that infects mainly the gastrointestinal tract of humans and several mammals, such as wild pigs, cattle, sheep, and goats [1]. She had no history of clinically significant underlying diseases; she was not receiving any drug treatments; and she did not drink alcohol or smoke Her physical examination revealed that she was well; her weight was 41 kg, and her body temperature was 37.2 °C, pulse rate was 103 beats/minute, blood pressure was 116/70 mmHg, and respiratory rate was 20 breaths/minute. Routine laboratory tests (Table 1) showed that she had a mild microcytic anemia (hemoglobin 9.4 mg/dl, mean corpuscular volume 73 fl) Her serum total protein and albumin concentrations were low, but she had hyperglobulinemia and raised liver enzymes (aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase). Her serum creatinine was 0.82 mg/dl, for an estimated glomerular filtration rate (eGFR) of 85.49 ml/min/1.73 m2, blood urea nitrogen (BUN) 21.20 mg/dl, sodium 137 mEq/L, potassium 4.0 mEq/L, and chloride 103 mEq/L Her hepatitis (anti-hepatitis C virus antibodies, hepatitis B surface antigen) and human immunodeficiency virus serology results were negative. She was prescribed tetracycline 500 mg four times daily for 10 days, after which the result of a posttreatment urine examination was negative for B. coli
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