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Proliferative glomerulonephritis with monoclonal IgG Lambda deposits caused by plasmablastic lymphoma: a case report
Ling-Yan Ren1, Qi Chen1, Feng-Ping Qiu1
1Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China.
This case report details a rare instance of plasmablastic lymphoma (PBL) in an HIV-negative patient, presenting with nephrotic syndrome and kidney disease. The study highlights a novel association between PBL secreting monoclonal IgG lambda and proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID).
Area of Science:
- Hematology
- Nephrology
- Oncology
Background:
- Plasmablastic lymphoma (PBL) is a rare B-cell lymphoma typically associated with immunosuppression, often originating in the gastrointestinal tract, particularly the oral cavity in HIV-positive individuals.
- Abdominal cavity involvement and secondary kidney disease are exceptionally uncommon presentations of PBL.
Observation:
- A case of an HIV-negative female presenting with nephrotic syndrome, renal insufficiency, and lymphadenopathy.
- Ascitic fluid analysis revealed plasmablast-like lymphocytes with lambda light chain restriction.
- Renal biopsy confirmed proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID).
Findings:
- The PGNMID was attributed to monoclonal IgG lambda secreted by PBL.
- Monoclonal IgG lambda expression was detected in kidney tissue before systemic blood detection.
- This represents the first reported case of PGNMID secondary to PBL-secreted monoclonal IgG lambda.
Implications:
- This case expands the known clinical spectrum of PBL, particularly in HIV-negative individuals.
- It underscores the importance of considering PBL in the differential diagnosis of nephrotic syndrome with lymphadenopathy.
- Early detection of monoclonal immunoglobulin deposits in the kidney may be crucial for timely diagnosis and management of PBL-associated renal disease.
