Pregnancy-associated dense deposit disease with neurological complications caused by Salmonella Typhi: A case report

Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of renal dysfunction and is increasingly being reclassified into immune complex-mediated and complement-mediated forms. Infections, particularly in endemic regions, may act as disease triggers. Pregnancy further complicates renal pathology through physiological and immunological changes.

We describe a 22-year-old pregnant woman presenting with generalized edema, proteinuria, and cola-colored urine. Renal biopsy revealed diffuse endocapillary proliferation with mesangial and capillary wall C3 deposition, consistent with immune complex-mediated MPGN, with ultrastructural features suggestive of dense deposit disease (DDD). During hospitalization, she developed fever, papilledema, and neurological deficits. Blood cultures grew Salmonella Typhi, and urine cultures isolated vancomycin-resistant Enterococcus. Targeted antimicrobial therapy improved systemic symptoms, while cyclosporine was initiated for persistent proteinuria.

This case report illustrates an atypical presentation of DDD during pregnancy, potentially triggered by typhoid fever and complicated by neurological involvement. It underscores the diagnostic challenges in resource-limited settings and the complex interplay among infection, complement dysregulation, and gestation.

This case report illustrates an atypical presentation of MPGN during pregnancy, triggered by typhoid fever and complicated by multidrug-resistant infection and neurological involvement. The patient's renal and neurological symptoms improved with antibiotics and supportive care; however, the pregnancy resulted in intrauterine fetal demise at 28 weeks. Early recognition and multidisciplinary care were pivotal to maternal stabilization and fetal management.