Case 34
With discussion
Versión en Español

CASE 34 (December 2008)

Clinical information

A 19-year-old women presented with a 4-weeks history of polyarthralgia, hemolytic anemia, and bilateral pleural effusion. ANAs: 1:640 homogeneous pattern, native anti-DNA: 1:320; C3 28 mg/dL (90-180), C4 4.4 mg/dL (10-40). Anti-SM and anti-RNP in normal values.

Serum creatinine: 0.7 mg/dL, BUN: 15.0 mg/dL. Proteinuria 1.17 g/24h; there is not hematuria or casts, there is not active sediment.

With a diagnosis of SLE a renal biopsy is carried out to know renal involvement degree. See the images.

Figure 1. H&E, X200.

Figure 2. H&E, X400.

Figure 3. PAS, X400.

Figure 4.Methenamine-silver stain, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X1,000.

Figure 7. Direct immunofluorescence using antiserum to IgG, X400.

Figure 8. Direct immunofluorescence using antiserum to C3, X400.

Direct immunofluorescence for IgA, IgM, and C1q show mesangial deposits similar to images shown for IgG and C3.

What is your diagnosis?

See diagnosis and discussion