Membranous glomerulopathy in an adult patient with X-linked agammaglobulinemia receiving intravenous gammaglobulin.
J Investig Allergol Clin Immunol 2011;
21:405-409. [PMID:
21905506 PMCID:
PMC3667600]
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Abstract
BACKGROUND
Immune complex deposition in the subepithelial zone of glomerular capillaries can lead to membranous glomerulopathy.
OBJECTIVE
To present the case of a 23-year-old man with X-linked agammaglobulinemia (XLA) who developed idiopathic membranous glomerulopathy while receiving intravenous immunoglobulin (IVIG).
METHODS
We performed an immunological workup, genetic testing, and a renal biopsy.
RESULTS
XLA was confirmed with less than 0.02% CD19+ cells in the blood after sequence analysis revealed a nonfunctional BTK gene. The patient presented with microhematuria, which persisted for 3 years and spanned treatment with 5 different preparations of intravenous gammaglobulin. Immunohistochemistry revealed membranous glomerulopathy.
CONCLUSION
Although endogenous serum immunoglobulin (Ig) production is severely impaired in XLA, rare B lymphocytes that have managed to mature can produce functional IgG antibodies. The pathogenic immune complexes could reflect IVIG reacting with polymorphic autoantigens, an endogenous IgG-producing clone reacting with a common idiotype present in the IVIG, or both.
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