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Wijayaratne DR, Heptinstall L, Garibotto G, Verzola D, Gaggero G, Parodi A, Pepper RJ. Secondary Membranous Nephropathy Due to Benign Tumors in 2 Young Women: A Case Report. Kidney Med 2021; 4:100397. [PMID: 35243309 PMCID: PMC8861965 DOI: 10.1016/j.xkme.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Membranous nephropathy (MN) is one of the most common causes of adult-onset nephrotic syndrome. We describe the cases of 2 young women in their 20s presenting with nephrotic syndrome due to antiphospholipase A2 receptor (anti-PLA2R)–negative MN, that was found to be associated with benign tumors. Both women had no extrarenal symptoms of a connective tissue disease, infection, or malignancy. They both had been previously healthy and were not receiving treatment with any drugs. Both had MN on kidney biopsy. Biopsies were negative for PLA2R antigen, and their serum did not demonstrate the presence of anti-PLA2R antibodies. Both were investigated for a secondary cause on the basis of negative anti-PLA2R serology and biopsy features supportive of secondary MN and were found to have benign tumors on radioimaging: a uterine leiomyoma and mesenteric fibromatosis, respectively. In both instances, the nephrotic syndrome remitted following resection of the tumors. To our knowledge, uterine leiomyoma and mesenteric fibromatosis have not previously been described in association with MN. These cases highlight the importance of pursuing a secondary cause of MN in patients without anti-PLA2R antibodies in serum or PLA2R antigen on kidney biopsy.
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Affiliation(s)
- Dilushi R. Wijayaratne
- Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
- Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
| | - Lauren Heptinstall
- Department of Cellular Pathology, Royal Free Hospital, London, United Kingdom
| | - Giacomo Garibotto
- Clinica Nefrologica, Dialisi e Trapianto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genoa, Italy
| | - Daniela Verzola
- Dipartimento di medicina interna (DIMI), Università degli studi di Genova, Genoa, Italy
| | - Gabriele Gaggero
- UO Anatomia Patologica, Opsedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy
| | - Angelica Parodi
- Clinica Nefrologica, Dialisi e Trapianto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genoa, Italy
| | - Ruth J. Pepper
- Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
- Address for Correspondence: Ruth J. Pepper, PhD, Royal Free Hospital, Pond Street, Hampstead, London NW32QG, United Kingdom.
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Tajima Y, Yaguchi H, Mito Y. Non-motor Comorbidity of Myasthenia Gravis: Myasthenia Gravis as a Systemic Immunological Disorder Involving Non-motor Systems. Intern Med 2019; 58:1341-1347. [PMID: 30568129 PMCID: PMC6543207 DOI: 10.2169/internalmedicine.1990-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To explore non-motor comorbidities of myasthenia gravis (MG), we present two cases of thymoma-associated MG patients. Alopecia, pure red cell aplasia, and thymoma- associated multiorgan autoimmunity were observed in Case 1, and alopecia, thrombocytopenia, hypogammaglobulinemia and nephrotic syndrome were observed in Case 2. In both cases, autoreactive T lymphocytes inappropriately stimulated by thymus tissue may have played key roles in generating the various autoimmune-associated symptoms. Consequently, systemic immunological involvement due to the thymoma-associated breakdown of immunoregulations in both motor and non-motor systems should be considered in MG patients.
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Affiliation(s)
- Yasutaka Tajima
- Department of Neurology, Brain Science Centre, Sapporo City General Hospital, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Brain Science Centre, Sapporo City General Hospital, Japan
| | - Yasunori Mito
- Department of Neurology, Brain Science Centre, Sapporo City General Hospital, Japan
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Ozaki K, Ohkubo T, Yamada T, Yoshioka K, Ichijo M, Majima T, Kudo S, Akashi T, Honda K, Ito E, Watanabe M, Sekine M, Hamagaki M, Eishi Y, Sanjo N, Ishibashi S, Mizusawa H, Yokota T. Progressive Encephalomyelitis with Rigidity and Myoclonus Resolving after Thymectomy with Subsequent Anasarca: An Autopsy Case. Intern Med 2018; 57:3451-3458. [PMID: 29984771 PMCID: PMC6306531 DOI: 10.2169/internalmedicine.1238-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an autoimmune disorder involving the brainstem and spinal cord and is sometimes associated with thymoma. We encountered a 75-year-old woman with typical PERM features, glycine receptor antibody, and thymoma. Her neurologic symptoms improved after thymectomy, but she unexpectedly developed anasarca with massive pleural effusions and hypoalbuminemia and finally succumbed to death. The autopsy showed edema and mononuclear infiltration in the pleura but no neuropathological findings typical of PERM. Effective treatment of PERM can reverse the neuropathological signs of encephalomyelitis. The autoimmune nature of anasarca is possible but not proven.
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Affiliation(s)
- Kokoro Ozaki
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tetsuo Yamada
- Department of Clinical Laboratory Medicine, Graduate School of Health Care Science, Bunkyo Gakuin University, Japan
| | - Kotaro Yoshioka
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Masahiko Ichijo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takamasa Majima
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Shunsuke Kudo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takumi Akashi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Keiji Honda
- Department of Otolaryngology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eisaku Ito
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Mayumi Watanabe
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Masaki Sekine
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Miwako Hamagaki
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yoshinobu Eishi
- Department of Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Nobuo Sanjo
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Satoru Ishibashi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hidehiro Mizusawa
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- The National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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