Use of Immunosuppressive Therapy in the Treatment of IgA-dominant Infection-related Glomerulonephritis

• Published in: Internal Medicine Vol. 61; no. 5; pp. 697 - 701
• Main Authors: Okumura, Motohiro, Sugihara, Shinnosuke, Seki, Kurumi, Nagaoka, Kanako, Okawa, Naoki, Ebihara, Masayuki, Inoue, Takahiro, Fukuda, Junko, Ohara, Mamiko, Imasawa, Toshiyuki, Kitamura, Hiroshi, Oda, Takashi, Suzuki, Tomo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.03.2022; Japan Science and Technology Agency
• Subjects: Biopsy; Case Report; Cellulitis; Chemotherapy; Colon cancer; Cyclophosphamide; Galactose; galactose-deficient IgA1; Glomerulonephritis; Glomerulonephritis - etiology; Glomerulonephritis, IGA - complications; Glucocorticoids; Humans; Immunofluorescence; Immunoglobulin A; Immunosuppression Therapy; Immunosuppressive agents; immunosuppressive therapy; infection-related glomerulonephritis; Infections; Internal medicine; Male; Metastases; Middle Aged; Neoplasm Recurrence, Local - complications; Nephritis; nephritis-associated plasmin receptor (NAPlr); Neutropenia; Patients; Plasmin; Proliferative kidney disease; Purpura; Renal function; immunosuppressive therapy; nephritis-associated plasmin receptor (NAPlr); galactose-deficient IgA1; infection-related glomerulonephritis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.7404-21

A 51-year-old Japanese man who experienced colon cancer recurrence following primary and metastatic lesion resection was hospitalized due to facial cellulitis with febrile neutropenia and purpura on his lower extremities after chemotherapy. It was complicated by rapidly progressive glomerulonephritis. He was diagnosed with immunoglobulin A (IgA)-dominant endocapillary proliferative glomerulonephritis based on kidney histology. His glomeruli were positive for the nephritis-associated plasmin receptor, plasmin activity and galactose-deficient IgA1 (Gd-IgA1). A skin biopsy immunofluorescence study revealed IgA deposition within perivascular regions but no Gd-IgA1 deposition. The final diagnosis was IgA-dominant infection-related glomerulonephritis (IRGN). The patient's renal function returned to normal after receiving immunosuppressive therapy that consisted of a glucocorticoid and a cyclophosphamide. Immunosuppressive therapy should be considered in cases of IRGN if the patient's infection is completely under control.