title: Lupus nephritis and non-Hodgkin lymphoma simultaneously diagnosed in a patient on methimazole.
abstract: A 78 year old white male on methimazole due to Grave's thyroiditis presented with acute renal failure after a short term history of progressive shortness of breath, malaise, myalgias, arthralgias, and bilateral lower limb swelling. The abdomen was remarkable for splenomegaly and lower extremities for erythema nodosum. No peripheral lymphadenopathy was detected. Serum albumin was 1.7 g/dl and very high erythrocyte sedimentation rate. Urine sediment was very active with dysmorphic red blood cells and casts and significant proteinuria (6.6 grams/day). Serum complements were abnormally low and antinuclear and anti-DNA antibodies were positive. Renal histopathology revealed membranoproliferative glomerulonephritis, along with a full house pattern on IFF consistent with lupus nephritis. Bone marrow aspiration revealed a 40% infiltration by a lymphocyte population of small cells consistent with a B cell non-Hodgkin lymphoma. The patient was treated with methylprednisolone, cyclophosphamide and rituximab and acute dialysis. Over the following weeks the patient became dialysis independent and returned to his baseline GFR.
authors.affiliation: Nephrology and Transplantation Department, Laiko Hospital, Greece. sofia.lionaki@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Lionaki
authors.forename: G
authors.initials: G
authors.lastname: Vlachopanos
authors.forename: A
authors.initials: A
authors.lastname: Georgalis
authors.forename: P
authors.initials: P
authors.lastname: Ziakas
authors.forename: H
authors.initials: H
authors.lastname: Gakiopoulou
authors.forename: C
authors.initials: C
authors.lastname: Petra
authors.forename: J
authors.initials: J
authors.lastname: Boletis
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000009:adverse effects*; D001707:Biopsy, Needle; D001856:Bone Marrow Examination; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006111:Graves Disease / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D008713:Methimazole / Q000009:adverse effects*; D008775:Methylprednisolone / Q000627:therapeutic use; D006435:Renal Dialysis; D012307:Risk Factors; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D013956:Antithyroid Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab; D008713:Methimazole; D003520:Cyclophosphamide; D008775:Methylprednisolone