%0 Journal Article
%T A case of IgG4-related tubulointerstitial nephritis concurrent with Henoch-Sch£¿nlein purpura nephritis
%A Rukako Tamai
%A Yoshiyuki Hasegawa
%A Satoshi Hisano
%A Katsuhisa Miyake
%A Hitoshi Nakashima
%A Takao Saito
%J Allergy, Asthma & Clinical Immunology
%D 2011
%I BioMed Central
%R 10.1186/1710-1492-7-5
%X A novel clinicopathological entity of IgG4-related autoimmune disease characterized by extensive IgG4-positive plasma cell infiltration of organs together with CD4- or CD8-positive T lymphocytes is proposed [1]. Renal involvement in this entity was also suggested, and three patterns of renal involvement have been described: 1) extraparenchymal involvement such as hydronephrosis associated with retroperitoneal lesions; 2) diffuse tubulointerstitial nephritis (TIN); and 3) renal lesions composed of focal lymphoplasmacytic infiltration of the renal interstitium [2]. In this report we describe a rare case diagnosed with HSP nephritis that was complicated by IgG4-related nephropathy.A 72-year-old man presented with cervical, axillary, left subclavian, and inguinal lymph nodes (LNs) swelling. The LNs gradually increased in size for 1 month. During this period, the patient often had a low-grade fever and arthralgia. He also experienced a marked weight loss of 7 kg in 3 months. In June 2009, he developed an erythematous rash predominantly on his lower legs and was admitted to the hospital. In 2005, he had developed similar erythematous rashes in the lower extremities several times. In 2006, the patient was diagnosed with Henoch-Sch£¿nlein purpura (HSP) on the basis of histological examination of skin biopsy samples, which showed leukocytoclastic vasculitis. Immunohistochemical study with anti-IgA antibody was not performed. A treatment with prednisolone (PSL; 25 mg) had been effective (Figure 1). He had no history of allergic diseases such as bronchial asthma, atopic dermatitis, and allergic rhinitis. In 2002, he underwent gastrectomy for gastric cancer.On admission, he was febrile, and the rash was palpable and purpuric in nature. A physical examination showed no abnormalities in the lungs, heart, abdomen, and central nervous system. Laboratory findings showed an increased erythrocyte sedimentation rate (73 mm/h) and the value of C-reactive protein was 0.22 mg/dL. The hemog
%U http://www.aacijournal.com/content/7/1/5