A case report of varicella-zoster virus infection associated glomerulonephritis and encephalitis.

15-year-old boy was admitted with nephritic and nephrotic syndrome, renal dysfunction and decreased serum C3, who suffered from varicella for two months. His renal histopathology revealed endocapillary proliferative glomerulonephritis with podocytes proliferation and severe tubular injury by light microscopy. Direct immunofluorescence showed global granular deposition of IgG, IgA, IgM, C3, C1q and fibrinogen in mesangium and along glomerular capillary wall. Electron microscopic examination showed electron-dense deposits in multiple sites of glomeruli. Furthermore, specific serum IgM antibodies against varicella-zoster virus (VZV) were detected. VZV antigen and mRNA were demonstrated in glomerular and tubular epithelial cells by immunohistochemical staining and in-situ hybridization. Virus particles and virus inclusions were identified by electron microscopy and special staining (Methylene Blue and Eosion staining or Mann staining). The patient also experienced epileptic episodes and his brain MRI and electroencephalogram indicated herpes encephalitis with secondary epilepsy. Therefore, the diagnosis of VZV-associated glomerulonephritis and encephalitis was established. This is the first case of VZV-associated glomerulonephritis with renal histopathological evidence using in situ hybridization technique.