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IgA vasculitis with nephritis accompanied by pulmonary tuberculosis: a case report
Eriko Abe1,2, Ryu Kobayashi3, Rio Matsuoka1
1Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
CEN Case Reports
|January 9, 2025
Summary
A rare case of IgA vasculitis with nephritis (IgAVN) associated with pulmonary tuberculosis in an adult was successfully treated. Prompt intervention with corticosteroids and supportive therapies led to complete remission of nephritis symptoms.
Area of Science:
- Nephrology
- Immunology
- Infectious Diseases
Background:
- IgA vasculitis with nephritis (IgAVN) is an immune complex-mediated condition.
- While often post-infectious, IgAVN rarely presents with pulmonary tuberculosis.
- Adult-onset IgAVN can be severe, often indicating a poor prognosis.
Purpose of the Study:
- To report a unique case of adult-onset IgAVN associated with pulmonary tuberculosis.
- To describe the diagnostic findings and treatment approach for this rare complication.
- To highlight the successful management and recovery in a challenging clinical scenario.
Main Methods:
- Clinical presentation of abdominal pain, purpura, proteinuria, and hematuria.
- Diagnostic skin and renal biopsies revealing IgA-positive leukocytoclastic vasculitis and IgA-positive mesangial proliferative glomerulonephritis with crescent formation.
- Immunohistochemical staining for galactose-deficient IgA1 and nephritis-associated plasmin receptor.
Main Results:
- Diagnosis of IgA vasculitis with nephritis (IgAVN) associated with pulmonary tuberculosis.
- Positive staining for galactose-deficient IgA1 and nephritis-associated plasmin receptor.
- Successful treatment with corticosteroids, factor XIII supplementation, renin-aldosterone-system inhibitor, and SGLT2 inhibitor, leading to complete remission of proteinuria.
Conclusions:
- IgAVN can rarely be associated with pulmonary tuberculosis in adults.
- Multifaceted treatment approach is effective in managing severe adult-onset IgAVN.
- Early diagnosis and comprehensive therapy are crucial for favorable outcomes in IgAVN, even with concurrent infections.
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