Abe Eriko, Kobayashi Ryu, Matsuoka Rio, Kanaoka Tomohiko, Yamanaka Shoji, Fujii Satoshi, Koike Junki, Oda Takashi, Wakui Hiromichi, Tamura Kouichi
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Nephrology and Hypertension, Saseikai Yokohamashi Nanbu Hospital, Yokohama, Japan.
CEN Case Rep. 2025 Jun;14(3):421-427. doi: 10.1007/s13730-025-00966-7. Epub 2025 Jan 9.
A 69-year-old Japanese man developed abdominal pain, purpura, proteinuria, and hematuria while receiving treatment for pulmonary tuberculosis. A skin biopsy revealed IgA-positive leukocytoclastic vasculitis, and a renal biopsy showed IgA-positive mesangial proliferative glomerulonephritis with crescent formation. Based on these findings, we diagnosed IgA vasculitis with nephritis (IgAVN) and initiated treatment. The patient's abdominal symptoms improved following factor XIII supplementation and corticosteroids. Corticosteroids were administered, and after 5 months, the proteinuria was in complete remission. Although IgAVN often follows a prior infection, it is rarely complicated by tuberculosis. In this case, staining for galactose-deficient IgA1, which is specifically positive in IgA nephropathy and IgAVN, was positive. Nephritis-associated plasmin receptor staining was also positive, suggesting some involvement of infectious glomerulonephritis. Therefore, the patient was considered to have IgAVN associated with pulmonary tuberculosis. In adult-onset cases, IgAVN is often severe. This patient was presented with adult-onset nephrosis and International Study of Kidney Disease in Children grade IIIb IgAVN, suggesting a poor prognosis. Therefore, we immediately initiated treatment with corticosteroids, factor XIII supplementation, a renin-aldosterone-system inhibitor, and a sodium-glucose cotransporter 2 inhibitor. The patient recovered uneventfully with no worsening of tuberculosis.
一名69岁的日本男性在接受肺结核治疗期间出现腹痛、紫癜、蛋白尿和血尿。皮肤活检显示IgA阳性白细胞破碎性血管炎，肾脏活检显示IgA阳性系膜增生性肾小球肾炎伴新月体形成。基于这些发现，我们诊断为IgA血管炎伴肾炎（IgAVN）并开始治疗。补充凝血因子XIII和使用糖皮质激素后，患者的腹部症状有所改善。给予糖皮质激素治疗，5个月后蛋白尿完全缓解。虽然IgAVN常继发于先前感染，但很少并发肺结核。在该病例中，在IgA肾病和IgAVN中特异性呈阳性的半乳糖缺乏IgA1染色呈阳性。肾炎相关纤溶酶受体染色也呈阳性，提示存在感染性肾小球肾炎。因此，该患者被认为患有与肺结核相关的IgAVN。在成人发病的病例中，IgAVN通常较为严重。该患者表现为成人起病的肾病和儿童肾脏病国际研究IIIb级IgAVN，提示预后不良。因此，我们立即开始使用糖皮质激素、补充凝血因子XIII、肾素-血管紧张素-醛固酮系统抑制剂和钠-葡萄糖协同转运蛋白2抑制剂进行治疗。患者顺利康复，肺结核未恶化。
