title: Membranous glomerulopathy and massive cervical lymphadenopathy due to immunoglobulin G4-disease.
abstract: A 32-year-old male presented with acute and severe nephrotic syndrome as well as massive right cervical lymphadenopathy for <2 years. Computed tomography scan of the chest, abdomen, and pelvis did not reveal any lymphadenopathy. Histopathology and immunohistochemical testing of his lymph node biopsy showed infiltrate enriched with immunoglobulin G4 (IgG4)-positive plasma cells. His kidney biopsy showed granular membranous deposits of IgG4 in the basement membrane without interstitial infiltrate. Antiphospholipid 2 receptor antibodies were absent excluding its "idiopathic" nature. Since he was allergic to rituximab, he was treated with corticosteroids for two months and a combination of tacrolimus and mycophenolate. His lymphadenopathy disappeared, and his proteinuria abated. The dose of the latter two medications was reduced to half after four months and will be maintained for a minimum of two years to prevent relapse of his disease.
authors.affiliation: Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: Kamel
authors.initials: K
authors.lastname: El-Reshaid
authors.affiliation: Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Shaikha
authors.initials: S
authors.lastname: Al-Bader
authors.affiliation: Department of Pathology, Al-Amiri Hospital, Kuwait City, Kuwait.
authors.forename: John
authors.initials: J
authors.lastname: Madda
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001706:Biopsy; D004359:Drug Therapy, Combination; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D000077733:Immunoglobulin G4-Related Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000187:drug effects / Q000276:immunology* / Q000473:pathology; D008198:Lymph Nodes / Q000187:drug effects / Q000276:immunology* / Q000473:pathology; D000072281:Lymphadenopathy / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus