Abeysekera Rajitha Asanga, Wazil Abdul Wahid Mohomad, Nanayakkara Nishantha, Ratnatunga Neelakanthi, Fernando Kaushal Maithree, Thinnarachchi Jalitha
Nephrology and Transplantation Unit, Teaching Hospital, Kandy, Sri Lanka.
Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
J Med Case Rep. 2015 May 19;9:115. doi: 10.1186/s13256-015-0583-y.
Kidney involvement in non-Hodgkin lymphoma is recognized but mostly diagnosed following a diagnosis of lymphoma. We describe a rare case of mantle cell lymphoma, a B-cell-type non-Hodgkin lymphoma, first presenting with immune complex glomerulonephritis.
We report the case of a 58-year-old Sri Lankan man who presented with gross hematuria. Further investigation revealed bicytopenia with splenomegaly and elevated serum creatinine. He had a renal biopsy, which revealed acute immune complex glomerulonephritis with interstitial inflammation. Results from an initial bone marrow biopsy and blood imaging were inconclusive. Three months later his renal function had deteriorated and a lymph node biopsy revealed mantle cell lymphoma. Within three months of initiating chemotherapy, his renal function returned to normal levels and remained normal at one year of follow-up.
It is important to have a high degree of suspicion when patients present with acute immune complex glomerulonephritis with no other identifiable cause, because it could be the first presentation of a non-Hodgkin lymphoma such as mantle cell lymphoma.
肾脏受累于非霍奇金淋巴瘤已得到公认，但大多是在淋巴瘤确诊后才被诊断出来。我们描述了一例罕见的套细胞淋巴瘤病例，这是一种B细胞型非霍奇金淋巴瘤，最初表现为免疫复合物性肾小球肾炎。
我们报告了一名58岁斯里兰卡男性的病例，他出现肉眼血尿。进一步检查发现全血细胞减少伴脾肿大以及血清肌酐升高。他接受了肾活检，结果显示为伴有间质炎症的急性免疫复合物性肾小球肾炎。最初的骨髓活检和血液影像学检查结果不明确。三个月后，他的肾功能恶化，淋巴结活检显示为套细胞淋巴瘤。在开始化疗后的三个月内，他的肾功能恢复到正常水平，并且在随访一年时仍保持正常。
当患者出现无其他可识别病因的急性免疫复合物性肾小球肾炎时，高度怀疑是很重要的，因为这可能是非霍奇金淋巴瘤如套细胞淋巴瘤的首发表现。
