A male with angioimmunoblastic T-cell lymphoma and proliferative glomerulonephritis

Ann Hematol. 2004 Jul;83(7):455-9. doi: 10.1007/s00277-003-0828-5. Epub 2004 Mar 18.

Abstract

In this article we present the case report of a 67-year-old male with a nephrotic syndrome due to a proliferative glomerulonephritis, associated with an angioimmunoblastic T-cell lymphoma. Diagnosis was made on an axillary lymph node biopsy and showed expanded T-cell areas with multiple blood vessels, small mature lymphocytes, eosinophils, and plasma cells. A kidney biopsy was suggestive for a proliferative glomerulonephritis with intra- and extracapillary proliferation. Hypercellular glomeruli were seen, as well as multiple floride crescents. Interstitial edema and fibrosis were absent. Immunohistochemical reactions were negative; there was some mesangial reaction with IgM in the glomeruli. Treatment with high-dose corticosteroids was initiated, with clinical improvement, and was immediately followed by therapy with cyclophosphamide, hydroxydaunomycin, vincristine, and prednisone (CHOP), which induced complete remission with a follow-up of 1 year. To our knowledge, the association of angioimmunoblastic T-cell lymphoma and proliferative glomerulonephritis has only been described twice. It concerned elderly men who developed acute renal failure a couple of months after the diagnosis of an angioimmunoblastic T-cell lymphoma. In both, immunoglobulin-containing dense deposits within glomeruli were observed, which was not the case in our patient, where only some mesangial colorization of the IgM in the glomeruli was seen.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Autoantibodies / analysis
  • Biopsy
  • Bone Marrow / pathology
  • Cyclophosphamide / administration & dosage
  • Diabetes Mellitus, Type 2 / complications
  • Doxorubicin / administration & dosage
  • Glomerulonephritis, Membranoproliferative / etiology*
  • Glomerulonephritis, Membranoproliferative / pathology
  • Humans
  • Immunoblastic Lymphadenopathy / complications*
  • Immunoblastic Lymphadenopathy / diagnosis
  • Immunoblastic Lymphadenopathy / drug therapy
  • Immunoglobulin M / analysis
  • Kidney / pathology
  • Kidney Tubules / immunology
  • Lymphoma, T-Cell / complications*
  • Lymphoma, T-Cell / diagnosis
  • Lymphoma, T-Cell / drug therapy
  • Male
  • Nephrotic Syndrome / etiology
  • Prednisone / administration & dosage
  • Remission Induction
  • Vasculitis, Leukocytoclastic, Cutaneous / etiology
  • Vincristine / administration & dosage

Substances

  • Adrenal Cortex Hormones
  • Autoantibodies
  • Immunoglobulin M
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol