title: Treatment-resistant recurrent membranoproliferative glomerulonephritis in renal allograft responding to rituximab: case report.
abstract: We report a case of idiopathic membranoproliferative glomerulonephritis (MPGN) recurring 2 years after a living-unrelated kidney transplantation. The disease was refractory to intravenous immunoglobulin and plasmapheresis. Treatment with 2 doses of rituximab resulted in remission of the disease. The disease relapsed 18 months later after an episode of cytomegalovirus pneumonitis. After treatment of the pneumonitis, a lung biopsy was performed owing to persistent chest symptoms, which revealed bronchiolitis obliterans with organizing pneumonia. Bone marrow examination and culture revealed presence of acid-fast bacilli, and culture grew Mycobacterium tuberculosis. A repeated course of rituximab was withheld because of infection with tuberculosis, the patient's chest symptoms, and rare reports of noninfectious lung disease after the use of rituximab. The patient continues to have proteinuria with impaired kidney function.
authors.affiliation: Division of Nephrology, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: farooquima1@ngha.med.sa.
authors.forename: M
authors.initials: M
authors.lastname: Farooqui
authors.affiliation: Department of Pathology and Laboratory Medicine, King Abdullah International Medical Research Center and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: K
authors.initials: K
authors.lastname: Alsaad
authors.affiliation: Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: N
authors.initials: N
authors.lastname: Aloudah
authors.affiliation: Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: Alhamdan
mesh_terms: D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010956:Plasmapheresis; D011507:Proteinuria / Q000473:pathology; D020551:Pulse Therapy, Drug; D012008:Recurrence; D000069283:Rituximab / Q000627:therapeutic use*; D014184:Transplantation, Homologous; D017211:Treatment Failure
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab; D003404:Creatinine; D008775:Methylprednisolone