[T-cell lymphoma under immunosuppressive treatment in minimal change glomerulopathy with nephrotic syndrome]

A 43-year-old woman was admitted for treatment of a nephrotic syndrome with increasing oedema, ascites, dyspnoea and nausea during the preceding 2 weeks.

There was a proteinuria of 25 g daily. Renal biopsy (seven glomeruli) showed a minimal-change glomerulopathy.

Prednisone administration (1 mg/kg daily) achieved complete remission. In the course of this treatment the patient contracted listeriosis with encephalitis, which quickly responded to ampicillin and netilmicin. When the glucocorticoid dosage was reduced or the drug discontinued, the nephrotic syndrome recurred. Cyclosporin treatment was begun (5 mg/kg daily) and quickly led to another remission. 4 weeks after start of the treatment a reddish-blue nodule, about 2 cm in diameter, was noted on the right upper arm. Histologically it showed cutaneous infiltration of a medium-sized T-cell lymphoma. Other efflorescences were found on the trunk and the limbs. Cyclosporin treatment was at once discontinued and the cutaneous changes gradually regressed. There were no other manifestations of a lymphoma. A further recurrence of the nephrotic syndrome responded well to a short course of chlorambucil (cumulative dose 420 mg) and of prednisone with slow dose reduction. There has been no recurrence in the last year.