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

BACKGROUND: 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. CASE PRESENTATION: 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. DISCUSSION: 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. CONCLUSION: 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.