Vasculitis Associated with Non-Hodgkin’s Lymphoma

Maite Rivera, MD, Hospital Ramón y Cajal, Servicio de Nefrologia, Carretera de Colmenar km 9,100, E-28034 Madrid (Spain) Dear Sir, In the last few years, several types of glo-merulonephritis have been reported in patients with non-Hodgkin’s lymphoma (NHL) namely focal sclerosing, membranoprolifera-tive, mesangioproliferative as well as membranous nephropathy and crescentic glomerulonephritis [1-3]. Focal necrotizing glomer-ulonephritis associated with NHL is extremely uncommon [4-9]. We report a patient with vasculitis in whom a lymphoma was discovered following her death. A 72-year-old woman was admitted because of a 2-month history of fever, weight loss, dyspnea, hemoptysis and bilateral pul-monar infiltrates. On physical examination blood pressure was 120/70 mm Hg. Cutaneous lesions were absent. Lymphadenopathies and hepato-splenomegaly were not found. Analytical studies disclosed: erythrocyte sedimentation rate of 98 mm in the first hour, hemoglobin 8.3 g/dl, leukocyte count 14,900 cells/mm3, platelets 375,000/mm3; urea 220 mg/dl, serum creatinine 7.1 mg/dl. Proteinuria was 8 mg/ kg/day and urine red blood cells 108,000/min with hyaline and granular casts. Plasma proteins were 5.4 g/dl. Serum albumin was 3.2 g/dl. Transaminases were normal. Antinuclear antibodies, C3, C4 and CH50, serum immunoglobulins, cryoglob-ulins, hepatitis B surface antigen and hepatitis C virus antibodies were normal or negative. C-ANCA antibodies were negative and P-ANCA were positive (ELISA). Abdominal ultrasonography was normal. During the following days renal function deteriorated, and hemodialysis was started. A renal biopsy showed 4 glomeruli, all of them presenting focal fibrinoid necrosis of the glomerular tuft. Intense interstitial mononuclear cell infiltrates and atrophic tubules were found (fig. 1). Direct immunofluores-cence was negative for IgG, IgM, IgA and C3. The patient received oral prednisone (1 mg/kg/day) and cyclophosphamide (2 mg/ kg/day). Her general condition improved, fever disappeared and serum creatinine decreased to 5 mg/dl 7 days after treatment.