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CEN Case Reports

, Volume 7, Issue 2, pp 248–252 | Cite as

Concurrent isolated IgG2-positive membranous nephropathy and malignant B-cell lymphoma

  • Satoshi Shimada
  • Takashi Nakamichi
  • Gen Yamada
  • Kaori Narumi
  • Hajime Usubuchi
  • Tae Yamamoto
  • Satoshi Ichikawa
  • Noriko Fukuhara
  • Mariko Miyazaki
  • Hideo Harigae
  • Hiroshi Sato
  • Sadayoshi Ito
Case Report
  • 108 Downloads

Abstract

A recent systematic review showed that hematological malignancy is often complicated by membranous nephropathy (MN). Histologically, the deposition of IgG subclasses other than IgG4 may imply secondary MN, such as malignancy-associated MN (M-MN). We describe a very rare case of concurrent isolated IgG2-positive MN and B-cell lymphoma. An 83-year-old woman was hospitalized at our institute for facial and lower extremity edema persisting for 2 months. Laboratory tests showed urinary protein level of 10.8 g/day, serum albumin level of 1.6 g/dl, and serum creatinine level of 2.34 mg/dl. Soon after diagnosis of nephrotic syndrome, treatment with corticosteroid was initiated, but it proved to be ineffective. Renal biopsy showed isolated IgG2-positive MN with highly infiltrated CD20-positive lymphoid cells in the kidney. Computed tomography revealed systemic lymphadenopathy, and aberrant B-cells with immunoglobulin light chain restriction were detected in peripheral blood and bone marrow, which led to the diagnosis of mature B-cell lymphoma. Although rituximab (375 mg/m2/week) was administered, the patient suddenly died from gastrointestinal bleeding on day 40 of hospitalization. It is, thus, necessary to consider hematological malignancy when a diagnosis of MN is made. Further studies are expected to elucidate the pathogenesis and to help establish the adequate treatment for this rare situation.

Keywords

Membranous nephropathy B-cell lymphoma Rituximab Isolated IgG2-positive 

Notes

Acknowledgements

We appreciate Ryoko Saito for valuable advice on pathological findings and Kiyomi Kisu for her technical assistance.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Satoshi Shimada
    • 1
  • Takashi Nakamichi
    • 1
  • Gen Yamada
    • 1
  • Kaori Narumi
    • 1
  • Hajime Usubuchi
    • 3
  • Tae Yamamoto
    • 1
  • Satoshi Ichikawa
    • 2
  • Noriko Fukuhara
    • 2
  • Mariko Miyazaki
    • 1
  • Hideo Harigae
    • 2
  • Hiroshi Sato
    • 1
  • Sadayoshi Ito
    • 1
  1. 1.Division of Nephrology, Endocrinology and Vascular MedicineTohoku University Graduate School of MedicineAoba-kuJapan
  2. 2.Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
  3. 3.Department of PathologyTohoku University HospitalSendaiJapan

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