Open AccessMembranous glomerulopathy and massive cervical lymphadenopathy due to immunoglobulin G4-disease
Author(s) -
Kamel El-Reshaid,
Shaikha Al-Bader,
John Patrick Madda
Publication year - 2017
Publication title -
saudi journal of kidney diseases and transplantation/našrat amraḍ wa zira'aẗ al-kulaẗ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.268
H-Index - 30
eISSN - 2320-3838
pISSN - 1319-2442
DOI - 10.4103/1319-2442.198167
Subject(s) - medicine , cervical lymphadenopathy , pathology , nephrotic syndrome , proteinuria , lymphoma , glomerulopathy , rituximab , lymph node biopsy , histopathology , biopsy , cervical lymph nodes , kidney , gastroenterology , disease , cancer , metastasis
A 32-year-old male presented with acute and severe nephrotic syndrome as well as massive right cervical lymphadenopathy for <2 years. Computed tomography scan of the chest, abdomen, and pelvis did not reveal any lymphadenopathy. Histopathology and immunohistochemical testing of his lymph node biopsy showed infiltrate enriched with immunoglobulin G4 (IgG4)-positive plasma cells. His kidney biopsy showed granular membranous deposits of IgG4 in the basement membrane without interstitial infiltrate. Antiphospholipid 2 receptor antibodies were absent excluding its "idiopathic" nature. Since he was allergic to rituximab, he was treated with corticosteroids for two months and a combination of tacrolimus and mycophenolate. His lymphadenopathy disappeared, and his proteinuria abated. The dose of the latter two medications was reduced to half after four months and will be maintained for a minimum of two years to prevent relapse of his disease.