CASE 172 (June 2020)
A 27-year-old woman with HIV diagnosed 15 months previously and with irregular antiviral treatment is evaluated for presenting purpuric skin lesions, edema and general discomfort. Acute kidney injury, severe decrease in CD4 lymphocytes, histoplasmosis, and AIDS criteria are documented. The patient has received antibiotics and NSAIDs.
Serum creatinine: 1.9 mg / dL, BUN: 32 mg / dL. albumin: 3.4 g / dL. Proteinuria: 650 mg / 24h. Microhematuria and leukocyturia. Normal complement. There are no laboratory findings to suggest MAT.
Kidney biopsy is done. Look at the photomicrographs.
Figure 1. H&E, X400.
Figure 2. PAS, X400.
Figure 3. Methenamine-silver stain, X400.
Figure 4. H&E, X200.
Figure 5. H&E, X400.
Figure 6. H&E, X400.
Figure 7. PAS, X200.
Figure 8. Methenamine-silver stain, X200.
Figure 9. Methenamine-silver stain, X400.
Figure 10. H&E, X200. In addition to vascular lesions, there is marked tubulointerstitial inflammation.
Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative.
Stains for fungi, bacilli and various viruses: Negative.
What is your diagnosis?