Managing concurrent nephrotic syndrome, spontaneous bacterial peritonitis, and herpes zoster in an immunocompromised child: Diagnostic difficulties and treatment outcomes

Nephrotic syndrome (NS) is a disease characterized by heavy protein loss in the urine due to increased permeability of the glomerular membrane, leading to low levels of albumin in the blood. Several studies have shown that primary or secondary kidney disease, congenital infections, diabetes, lupus, cancer, or the use of certain medications can cause it. Therefore, this study aims to present a case of NS in a 9-year-old boy complicated by spontaneous bacterial peritonitis and herpes zoster. The patient presented to the emergency department with a 2-day history of worsening abdominal pain accompanied by fever, nausea, vomiting, and facial oedema. Assessment showed a previous diagnosis of NS at the age of 7, but the condition remained poorly controlled due to irregular medication compliance. As the condition worsened, lavage drainage was performed, and the patient was later diagnosed with septic shock. Antibiotics therapies were administered to address the underlying infection. During hospitalization, the patient developed skin lesions that appeared to be herpes zoster, which was related to an immunocompromised condition. The patient was discharged after clinical improvement, and treatment was continued through outpatient monitoring. This current study emphasized the importance of early and aggressive intervention, particularly in immunocompromised pediatric patients with double burdens, to achieve better clinical outcomes.