[A case of anti-phospholipid antibody syndrome associated with typical mesangiolysis]

An 18-years-old female was admitted to our hospital because of severe edema, that had developed within one week, and massive proteinuria. She has been given treatment for mild proteinuria and Raynaud's phenomenon. Before the edema developed, she complained of recurrent attack of migraine associated with scintillating scotoma. At admission, she was suffering from butterfly erythema, hydropericardium and ascites. The results of tests for antinuclear antibodies and ENA antibodies were negative, but those for BFP and IgG-anticardiolipin antibody were positive, and the platelet and complement levels were low. Renal biopsy revealed typical mesangiolysis without any sign of hyperplastic nephritis. Electron microscopy demonstrated the deposition of microfibrillar structures in the mesangial areas. She was diagnosed as having SLE-antiphospholipid antibody syndrome. After the administration of prednisolone 40mg/day, the edema, Raynaud's sign and proteinuria disappeared. Migraine was improved by the additional use of warfarin, and the platelet count was normalized. These findings suggest that in this case, acute nephrotic symptom developed due to hemangioendothelial injury caused by anti-phospholipid antibody.