CASE 190 (December 2021)

Clinical information

A 26-year-old woman is evaluated for lower limb edema, headache, and general malaise. She does not report other symptoms. She does not report a pathological history. Gyneco-obstetrics: no previous pregnancies; regular cycles, last menstruation 20 days before. On physical examination, she is hypertensive (160/100), without cardiac or respiratory alterations, with edema of the lower limbs and a swollen face; no skin lesions.

Paraclinical: Hb: 12.8 mg/dL, hematocrit: 35%, leukogram and platelets: normal. Serum creatinine: 2.1 mg/dL; BUN: 32 mg/dL. Proteinuria: 2.2 g/24h; serum albumin: 3.3 g/dL. Urinary sediment with 15-20 erythrocytes/hpf, leukocytes 5/hpf, without casts. ANAs: 1:160, anti-DNA: negative, C3: 74 (88-180), C3: 16 (15-40), other autoimmunity markers: negative. HIV: positive, with confirmatory test also positive and viral load: 110,000 copies/mL. CD4 count: 500 cells/mL. Viral hepatitis tests negative, VDRL: negative. Normal protein electrophoresis.

A kidney biopsy was done.

Figure 1. H&E, X100.

Figure 2. H&E, X400.

Figure 3. H&E, X400.

Figure 4. Masson's trichrome stain, X400.

Figure 5. Masson's trichrome stain, X400.

Figure 6. Masson's trichrome stain, X400.

Figure 7. Methenamine-silver stain, X400.

Figure 8. Methenamine-silver stain, X400.

Figure 9. Methenamine-silver stain, X400.

Figure 10. Direct immunofluorescence for IgA, X400.

Figure 11. Direct immunofluorescence for IgG, X400.

Figure 12. Direct immunofluorescence for IgM, X400.

Figure 13. Direct immunofluorescence for C3, X400.

Figure 14. Direct immunofluorescence for C1q, X400.

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