CASE 26 (April 2008)
Clinical information
A 17-year-old woman was evaluated in
the outpatient hospital by a history of 4 months of progressive edema.
Urinary volume was decreased. She presented episodic polyarthralgia without
erythema. On examination blood pressure: 160/100; limbs and facial edema.
Urinalysis: proteins: 3.18 g/24h; erythrocytes:
60 HPF; leukocytes: 15 HPF; serum creatinine: 1.17 mg/dL; creatinine clearance:
50 ml/min; BUN: 24 mg/dL; normocytic normochromic anemia. Tests for hepatitis
viruses and HIV: negative. C3: 32 mg/dL (90-180); C4: 4 mg/dL (10-40).
Bilateral pleural effusion.
What is your clinical diagnosis?
See the images.

Figure 1.
H&E, x100.

Figure 2.
H&E, X400.

Figure 3.
Masson's trichrome stain, X400.

Figure 4.
Methenamine-silver stain, X400.

Figure 5.
Methenamine-silver stain, X400.

Figure 6.
Methenamine-silver stain, X600.

Figure 7.
Left: Direct immunofluorescence using antiserum to IgA,
x400. Right: Direct immunofluorescence using antiserum to IgG,
x400.

Figure 8.
Left: Direct immunofluorescence using antiserum to C3,
x400. Right: Direct immunofluorescence using antiserum to C1q,
x400.
Direct immunofluorescence for IgM: Mild
positive granular immunstaining in capillary walls, similar to C1q image.
What is your diagnosis?
See
diagnosis and discussion
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