Membranous nephropathy with thrombotic microangiopathy-like lesions successfully treated with tocilizumab in a patient with idiopathic multicentric Castleman disease

摘要

Microscopic findings of the lung, skin, and kidney. a, b Lung biopsy at the age of 39 years. The lung tissue shows nodular lymphoid hyperplasia a with plasma cell infiltration (b). Hematoxylin and eosin (HE) staining. Scale bars 500 μm (a) and 20 μm (b). c, d Skin biopsy at the age of 40 years. In the skin tissue, nodular lymphoid hyperplasia (c) with plasma cell infiltration (d) is also observed. HE staining, scale bars 500 μm (c) and 20 μm (d). e–h First renal biopsy at the age of 45 years. The renal biopsy reveals severe tubulointerstitial nephritis e with plasma cell infiltration (f). Masson-Trichrome staining, scale bars 100 μm (e) and 20 μm (f). The glomeruli are enlarged (g), and the glomerular basement membrane shows spike and bubbling formations (h). Periodic acid silver methenamine-HE (PASM-HE) staining, scale bars 50 μm (g) and 10 μm (h)