CASE 155 (January 2019)
The patient is a 32-year-old woman with a history of systemic lupus erythematosus diagnosed two years earlier. She has presented mucocutaneous, joint and hematological alterations. Multiple immunosuppressive treatments. Now she is evaluated for presenting generalized edema, 2 weeks of evolution. She also presents malar erythema, aphthae, polyarthritis and anemia.
Paraclinics: Hb: 9.8 mg/dL, Hto; 38%, platelets: 280,000/mm2, ESR: 28 mm/h. Serum creatinine: 0.9 mg/dL, BUN; 14 mg/dL. Proteinuria: 7.9 g/24h, Total serum protein: 4.9 g/dL, albumin: 2.3 g/dL. Urinary sediment: erythrocytes: 3/hpf, leukocytes; 2/hpf. There are no casts. ANA: 1: 640. C3: 78 mg/dL (90-180), C4: 8.9 mg/dL (10-40), anti-DNA: 1:80. Anticardiolipins and lupus anticoagulant in normal values.
See the images of the renal biopsy.
Figure 1. H&E, X100.
Figure 2. H&E, X400.
Figure 3. H&E, X400.
Figure 4. Masson's trichrome stain, X200.
Figure 5. Masson's trichrome stain, X400.
Figure 6. PAS, X400.
Figure 7. Methenamine-silver, X400.
Figure 8. Methenamine-silver, X400.
Figure 9. EM, original magnification X2,100.
Figure 10. EM, original magnification X2,100.
Figure 11. EM, original magnification X2,100.
Figure 12. EM, original magnification X2,100.
Direct immunofluorescence for IgA, IgG, IgM, C3, C1q, kappa, and lambda: Negative.
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