Case
5 With discussion |
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CASE 5
Clinical information
A 47-years-old man presented with abdominal pain from one month ago, the pain is more intense in the last trhee days and localized in epigastrium. He related nausea and vomiting. Pain is irradiated to left shoulder.
Diarrhoea from several weeks ago, more intense in the last three days. Subjective fever; inespecific chronic osteomuscular pain; he have used NSAID from several months. General weakness and weight loss (10 Kg.) in the last 6 months.
The physical examination was unrevealing.
Presumptive diagnosis was "cholecystitis? pancreatitis? liver abscess?"
Laboratory tests: Hb: 9.9 mg/dL, white cells: 5,000 per mm3, neutrophils: 3,150; lymphocytes: 1,200; platelets: 120,000 per mm3, creatinine 24.9 mg/dL, BUN 150 mg/dL; potassium: 5.5 meq./L; calcium: 12; albumin: 3,5 g/dL. No hematuria; proteinuria: 270 mg/dL; urinary volume: 500 cc. Serum complement levels: normal, ANAs negative.
What is your clinical diagnosis?
Hemodialysis was started and a renal biopsy was undertaken.
See the images.
Figure 1. (H&E, x400). The glomeruli do not show any alteration with special stains.
Figure 2. (H&E, x400)
Figure 3. (H&E, x400). The interstitium shows inflammatory infiltrates (top) near to intratubular cylinders.
Figure 4. (H&E, x400)
Figure 5. (Masson's trichrome stain X400)
Figure 6. (Immunofluorescence using antiserum to IgA, X400)
Figure 7. (Immunofluorescence using antiserum to Kappa light chains, X400)
Immunofluorescence for IgA was slight in glomerular capillary.
Immunofluorescence for IgG, IgM, C3, C1q and lambda light chains were negative.
What is your diagnosis?