Membranous nephropathy in a patient with pulmonary tuberculosis infection and lung adenocarcinoma: a case report
Membranous nephropathy in a patient with pulmonary tuberculosis infection and lung adenocarcinoma: a case report
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DOI：
10.1007/s13730-021-00641-7
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发表时间：
2021-08-29
期刊：
影响因子：
1
通讯作者：
Tanaka, Hiroyuki
中科院分区：
文献类型：
--
作者：
Morimoto, Nobuhisa;Nagahama, Kiyotaka;Tanaka, Hiroyuki
我们报告一个结核感染合并肺腺癌的膜性肾病病例。一名50岁的菲律宾妇女进行了肾活检的评估蛋白尿和血尿。免疫荧光分析显示肾小球基底膜和系膜基质中IgG阳性染色，而电子显微镜显示存在上皮下沉积物，提示MN。为了筛查MN的继发性原因，我们对胸部和腹部进行了计算机断层扫描（CT），结果显示右肺中叶存在毛玻璃样阴影和主动脉旁淋巴结肿大。T-SPOT试验呈阳性，表明可能存在潜伏性结核病感染，因为她没有症状。随访胸部CT扫描显示持续存在磨玻璃样阴影，提示非感染性原因。由于不能排除肺癌的可能性，因此进行了胸腔镜下右中叶切除术和右下叶部分切除术。值得注意的是，肺的病理分析显示中叶腺癌和下叶上皮样肉芽肿，表明活动性结核感染。手术后一个月，开始抗结核治疗。此后，她的蛋白尿（术前已增加至6 g/gCre）开始减少。手术后5个月，患者完全缓解。缓解的速度表明结核病可能在MN的病因学中起主要作用。我们的病例强调了对MN患者进行感染和恶性肿瘤筛查的重要性，即使没有提示性症状。
We report a case of membranous nephropathy (MN) in a patient with tuberculosis infection and lung adenocarcinoma. A 50-year-old Filipino woman underwent a renal biopsy for the evaluation of proteinuria and hematuria. Immunofluorescence analysis revealed positive staining of IgG in the glomerular basement membrane and mesangial matrices, while electron microscopy demonstrated the presence of sub-epithelial deposits, suggesting MN. To screen for secondary causes of MN, we conducted a computed tomography (CT) scan of the chest and abdomen, which revealed a ground-glass opacity in the middle lobe of the right lung and an enlarged paraaortic lymph node. A T-SPOT test was positive, suggesting the possibility of a latent tuberculosis infection, as she was asymptomatic. A follow-up chest CT scan showed persistent presence of the ground-glass opacities, suggesting a non-infectious cause. Video-assisted thoracoscopic resection of the middle right lobe and partial resection of the lower right lobe were performed because the possibility of lung cancer could not be excluded. Notably, pathological analysis of the lung revealed adenocarcinoma in the middle lobe and epithelioid granuloma in the lower lobe, suggesting an active tuberculosis infection. One month after surgery, anti-tuberculosis treatment was initiated. Thereafter, her proteinuria, which had increased to 6 g/gCre preoperatively, began to decrease. Five months after surgery, the patient achieved complete remission. The speed of remission suggests that tuberculosis likely played a primary role in the etiology of MN. Our case underscores the importance of screening tests for infections and malignancies in patients with MN, even if suggestive symptoms are absent.