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Takayasu M, Hirayama K, Shimohata H, Kobayashi M, Koyama A. Staphylococcus aureus Infection-Related Glomerulonephritis with Dominant IgA Deposition. Int J Mol Sci 2022; 23:ijms23137482. [PMID: 35806487 PMCID: PMC9267153 DOI: 10.3390/ijms23137482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Since 1995, when we reported the case of a patient with glomerulonephritis with IgA deposition that occurred after a methicillin-resistant Staphylococcus aureus (MRSA) infection, many reports of MRSA infection-associated glomerulonephritis have accumulated. This disease is being systematized as Staphylococcus infection-associated glomerulonephritis (SAGN) in light of the apparent cause of infection, and as immunoglobulin A-dominant deposition infection-related glomerulonephritis (IgA-IRGN) in light of its histopathology. This glomerulonephritis usually presents as rapidly progressive glomerulonephritis or acute kidney injury with various degrees of proteinuria and microscopic hematuria along with an ongoing infection. Its renal pathology has shown several types of mesangial and/or endocapillary proliferative glomerulonephritis with various degrees of crescent formation and tubulointerstitial nephritis. IgA, IgG, and C3 staining in the mesangium and along the glomerular capillary walls have been observed on immunofluorescence examinations. A marked activation of T cells, an increase in specific variable regions of the T-cell receptor β-chain-positive cells, hypercytokinemia, and increased polyclonal immune complexes have also been observed in this glomerulonephritis. In the development of this disease, staphylococcal enterotoxin may be involved as a superantigen, but further investigations are needed to clarify the mechanisms underlying this disease. Here, we review 336 cases of IgA-IRGN and 218 cases of SAGN.
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Affiliation(s)
- Mamiko Takayasu
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
- Correspondence: ; Tel.: +81-29-887-1161
| | - Homare Shimohata
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Masaki Kobayashi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan; (M.T.); (H.S.); (M.K.)
| | - Akio Koyama
- Emeritus Professor, University of Tsukuba, Tsukuba 305-8577, Ibaraki, Japan;
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Zhao Y, Kim Y, Junghare M, Vakil V, Su X, Li F, Bu L. Galactose-Deficient IgA1 Deposits in Clear Cell Renal Cell Carcinoma-Related Henoch-Schönlein Purpura Nephritis. Case Rep Nephrol 2020; 2020:8828336. [PMID: 32908737 DOI: 10.1155/2020/8828336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022] Open
Abstract
Recent studies suggest that galactose-deficient IgA1 (Gd-IgA1) plays a role in the pathogenesis of primary IgA nephropathy (IgAN) and Henoch–Schönlein purpura nephritis (HSPN). Furthermore, immunostaining of KM55, an antibody that identifies Gd-IgA1, may be helpful to differentiate primary IgAN and HSPN from secondary causes of glomerular IgA deposition. We report sequential kidney biopsies of a malignancy-associated HSPN, showing intense glomerular mesangial IgA deposition at the initial kidney biopsy and dramatic decrease in disappearance of glomerular deposits after tumor removal. We demonstrate that the glomerular IgA deposition contains Gd-IgA1, detected by immunostaining of KM55, with similar distribution and intensity to IgA. This suggests that renal Gd-IgA1 deposition may play a role in the pathogenesis of malignancy-associated HSPN.
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Umemura H, Yamasaki O, Iwatsuki K. Leukocytoclastic vasculitis associated with immunoglobulin A lambda monoclonal gammopathy of undetermined significance: A case report and review of previously reported cases. J Dermatol 2018; 45:1009-1012. [PMID: 29766549 DOI: 10.1111/1346-8138.14466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
Leukocytoclastic vasculitis is often associated with immunoglobulin (Ig)A deposition on the vascular walls. IgA-associated leukocytoclastic vasculitis comprises various underlying diseases. Hematological disorders that can be minor triggers include multiple myeloma and monoclonal gammopathy of undetermined significance. Here, we present the case of a 78-year-old woman with leukocytoclastic vasculitis associated with monoclonal gammopathy of undetermined significance of the IgA lambda chain. Oral steroid administration initially showed remission of vasculitis; however, the condition recurred after four attempts of treatment withdrawal. We also reviewed previous reports of 14 cases of IgA-associated leukocytoclastic vasculitis, of which 11 were associated with multiple myeloma and three with monoclonal gammopathy of undetermined significance.
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Affiliation(s)
- Hiroshi Umemura
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Mandai S, Aoyagi M, Nagahama K, Arai Y, Hirasawa S, Aki S, Inaba N, Tanaka H, Tsuura Y, Tamura T, Sasaki S. Post-Staphylococcal infection Henoch–Schönlein purpura nephritis: a case report and review of the literature. Ren Fail 2013; 35:869-74. [DOI: 10.3109/0886022x.2013.794703] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boumediene A, Oblet C, Oruc Z, Duchez S, Morelle W, Huynh A, Pourrat J, Aldigier JC, Cogné M. Gammopathy with IgA mesangial deposition provides a monoclonal model of IgA nephritogenicity and offers new insights into its molecular mechanisms. Nephrol Dial Transplant 2011; 26:3930-7. [DOI: 10.1093/ndt/gfr131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mitsui H, Shibagaki N, Kawamura T, Matsue H, Shimada S. A clinical study of Henoch-Schönlein Purpura associated with malignancy. J Eur Acad Dermatol Venereol 2009; 23:394-401. [PMID: 19207675 DOI: 10.1111/j.1468-3083.2008.03065.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Malignancy has been reported as a causative factor of cutaneous vasculitis, although only two retrospective epidemiological studies have analysed the association between Henoch-Schönlein purpura (HSP) and malignancy to date. OBJECTIVE To analyse the association between adult HSP and malignancy. METHODS We retrospectively reviewed the medical records of patients and found 103 cases of HSP over the past 20 years. Fifty-three cases (aged > or = 41 years) were categorized to two groups including 'with malignancy' or 'without malignancy', so that we could analyse the differences of clinical features between them. We also compared our study to previous reports. RESULTS Twenty-three cases out of 53 patients exhibited underlying malignant tumours. We focused on nine patients in which malignant tumours were thought to be strongly associated. Seven of nine patients exhibited new metastatic lesions or died due to underlying cancer within 1-32 months. CONCLUSIONS An association between HSP and malignant disease might have important diagnostic and pathophysiologic implications.
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Affiliation(s)
- H Mitsui
- Department of Dermatology, University of Yamanashi, Japan.
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Uggeri S, Fabbian F, Catizone L. Henoch–Schönlein purpura due to methicillin-sensitive Staphylococcus aureus bacteremia from central venous catheterization. Clin Exp Nephrol 2008; 12:219-23. [DOI: 10.1007/s10157-007-0024-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 11/27/2007] [Indexed: 11/30/2022]
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Kim ID, Lee SG, Lee HJ, Jo WS, Choi YJ, Shin HJ, Chung JS, Cho GJ, Lee EY. A Case of Henoch-Schönlein Purpura Associated with Diffuse Large B Cell Lymphoma. Korean J Hematol 2007. [DOI: 10.5045/kjh.2007.42.2.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Il Du Kim
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Seung Geun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Hye Jeong Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Woo Sung Jo
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Young Jin Choi
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Ho Jin Shin
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Joo Seop Chung
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Goon Jae Cho
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Korea
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Affiliation(s)
- Paul S Kellerman
- Division of Nephrology, University of Wisconsin School of Medicine, Madison, WI, USA.
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Zurada JM, Ward KM, Grossman ME. Henoch-Schönlein purpura associated with malignancy in adults. J Am Acad Dermatol 2006; 55:S65-70. [PMID: 17052537 DOI: 10.1016/j.jaad.2005.10.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 09/28/2005] [Accepted: 10/05/2005] [Indexed: 11/22/2022]
Abstract
Malignancy is a well-known cause of cutaneous vasculitis. The occurrence of neoplasia and Henoch-Schönlein purpura (HSP) is rare and poorly understood in adults. A total of 31 cases have been reported in the world literature of adult malignancy-associated HSP. Patients were overwhelmingly male (94%) with a mean age of 60 years and presented predominantly with solid tumors (61%). The most frequent tumors were lung (nonsmall-cell) (n = 8), multiple myeloma (n = 5), prostate (n = 5), and non-Hodgkin's lymphoma (n = 3). The majority of patients (55%) developed HSP within 1 month of cancer diagnosis or detection of metastases. We present 3 cases of adults who, in the absence of known precipitating factors, developed HSP within 2 months of diagnosis of a solid tumor or metastases. We recommend that adults, especially older men who present with unexplained HSP, be evaluated for occult neoplasm. We also advise that patients with a known history of malignancy who present with HSP be evaluated for metastatic disease.
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Affiliation(s)
- Joanna M Zurada
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Denton MD, Digumarthy SR, Chua S, Colvin RB. Case records of the Massachusetts General Hospital. Case 20-2006. An 84-year-old man with staphylococcal bacteremia and renal failure. N Engl J Med 2006; 354:2803-13. [PMID: 16807418 DOI: 10.1056/nejmcpc069012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mark D Denton
- Renal Unit, Derriford Hospital, Plymouth, United Kingdom
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Eftychiou C, Samarkos M, Golfinopoulou S, Skoutelis A, Psarra A. Henoch-Schonlein purpura associated with methicillin-resistant Staphylococcus aureus infection. Am J Med 2006; 119:85-6. [PMID: 16431201 DOI: 10.1016/j.amjmed.2005.07.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 07/14/2005] [Accepted: 07/14/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Christos Eftychiou
- Fifth Department of Internal Medicine, Evangelismos Hospital, Athens, Greece.
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