Gamble C N, Kimchi A, Depner T A, Christensen D
Am J Clin Pathol. 1982 Mar;77(3):347-52. doi: 10.1093/ajcp/77.3.347.
A kidney and skin biopsy were performed on a patient who developed cryoglobulinemia, polyarthritis, a purpuric skin rash, and acute renal failure four years following jejunoileal bypass for morbid obesity. Morphologic studies revealed a diffuse glomerulonephritis characterized by the presence of numerous subendothelial deposits containing IgG, IgA, C3, Clq, C4, and properdin, and an acute dermal vasculitis associated with similar immune complex deposits. Identical immunoglobulin and complement components were present in the cryoglobulin. In addition, both the cryoglobulin and a renal biopsy eluate containing anti-IgG antibody and antibody against Klebsiella pneumoniae which were present in the patient's stool in large numbers. Combined therapy with steroids and chloramphenicol resulted in marked improvement in the patient's arthritis, skin rash, and renal function. The findings indicate that glomerulonephritis and dermal vasculitis due to the deposition of bacterial antigen-antibacterial antibody complexes may occur as part of a systemic immune complex disease complicating small intestinal bypass.
对一名病态肥胖患者进行空肠回肠旁路手术后四年出现冷球蛋白血症、多关节炎、紫癜性皮疹和急性肾衰竭的患者进行了肾脏和皮肤活检。形态学研究显示弥漫性肾小球肾炎，其特征为存在大量含IgG、IgA、C3、Clq、C4和备解素的内皮下沉积物，以及与类似免疫复合物沉积物相关的急性皮肤血管炎。冷球蛋白中存在相同的免疫球蛋白和补体成分。此外，冷球蛋白和肾活检洗脱液中均含有抗IgG抗体以及患者粪便中大量存在的抗肺炎克雷伯菌抗体。类固醇和氯霉素联合治疗使患者的关节炎、皮疹和肾功能得到显著改善。这些发现表明，由于细菌抗原-抗菌抗体复合物沉积导致的肾小球肾炎和皮肤血管炎可能作为小肠旁路术后并发的全身性免疫复合物疾病的一部分而出现。
