Membranoproliferative glomerulonephritis associated with multicentric angiofollicular lymph node hyperplasia. Case report and review of the literature.

A 14-year-old boy presented with fever, anemia, hepatosplenomegaly, generalized lymphadenopathy and nephrotic syndrome. Lymph node biopsy showed angiofollicular lymph node hyperplasia (generalized Castleman's disease) of the plasma cell type. Kidney biopsy showed membranoproliferative glomerulonephritis type 1. Complete remission was achieved with corticosteroid treatment and repeat kidney biopsy 22 months later showed complete resolution of the renal pathology. The association between membranoproliferative glomerulonephritis and multicentric angiofollicular lymph node hyperplasia, plasma cell type, has not previously been reported.     

Rapidly progressive interstitial renal fibrosis associated with Chinese herbal medications.

BACKGROUND/AIM: Nephropathy after ingestion of Chinese herbs is known as a rapidly progressive form of interstitial renal fibrosis after a slimming regimen containing aristolochic acid that was identified first in Belgium. Intake of traditional Chinese herbal medicines is very popular in Taiwan. So we looked for similar cases in our hospital. METHODS: From 1994 to 1998, we observed 20 Taiwanese patients who underwent renal biopsy for rapidly progressive renal failure of unknown origin. The medical history of these patients gave no clue to the origin of renal impairment, except for the administration of Chinese herbs before the development of renal failure in all cases. RESULTS: Although these patients took herbal medications from various sources for different purposes, their renal biopsy specimens showed strikingly similar histological patterns: extensive paucicellular interstitial fibrosis and tubular atrophy, but the glomeruli were apparently intact. They also had similar clinical features, such as a nearly normal blood pressure, obvious anemia, insignificant edema, low-grade proteinuria, and glucosuria. The renal function declined rapidly in most cases; 15 patients underwent dialysis within 3 months of renal biopsy, and 7 patients received emergency dialysis when they first came to our hospital. On clinical and morphological grounds, the nephropathy in our patients appears similar to Chinese herb nephropathy. CONCLUSIONS: Because of the diversity of the herbal regimens used, in addition to aristolochic acid, other unidentified phytotoxins may also play a role in this particular disease entity. There is a strong relation between rapidly progressive interstitial renal fibrosis and the consumption of Chinese herbs.     

An exceptional cause of renal colic. Castleman's tumor. Lymphonodular angiofollicular hyperplasia

The case of a 38-year-old man with renal colic due to compression by an abdominopelvic mass is reported. Histologic examination of the mass led to the diagnosis of giant lymph node hyperplasia or Castleman disease. Surgical removal of the lesion ensured complete recovery with no recurrence after 32 months follow up. Giant lymph node hyperplasia usually develops in the mediastinum, but superficial and abdominopelvic forms are seen occasionally. Pathogenic hypotheses are discussed. Outcome is usually favorable following surgical excision but rare multifocal forms with a potentially poor prognosis have been reported.     

Intrapericardial giant lymph node hyperplasia

This report concerns a female patient aged 42 years known to have asymptomatic cardiomegaly for 2 years. She presented 2 weeks before surgery with chest pain radiating to the left arm and face. Angiography revealed a highly vascular mass in the region of the left atrium. Surgery revealed an intrapericardial tumor adherent to both atria. Histologically this proved to be giant lymph node hyperplasia, an unusual example because of its intrapericardial localization.     

Membranous nephropathy associated with giant lymph node hyperplasia. A case report with histological and ultrastructural studies

A young woman presented with nephrotic syndrome due to membranous nephropathy and a localized form of giant lymph node hyperplasia (Castleman's disease) occurring as a large intra-abdominal mass. Five months after surgical removal of the mass, only mild proteinuria persisted. Twenty months later a second kidney biopsy showed a near-normal morphology. Six years later the patient was free of symptoms and had normal urinalysis. Reviewing the pertinent literature, it seems to be the first case of a biopsy-proven cure of membranous nephropathy in a patient with membranous nephropathy and Castleman's disease.     

Rapidly progressive laryngeal oedema associated with pregnancy-aggravated hypertension

We report a patient with pregnancy-aggravated hypertension who developed rapid progression of laryngeal oedema intraoperatively and in whom airway obstruction occurred immediately following extubation. There were no pre-operative signs to indicate potential airway problems.     

Giant lymph node hyperplasia of the lung (Castleman''s disease) associated with recurrent pleural effusion.

A case of giant lymph node hyperplasia (Castleman's disease) of the lung presented with pleural effusion (which was recurrent), an unusual complication. The patient was treated with pneumonectomy and has survived for three years without relapse. This is the first report of the disease from black Africa.     

Rapidly progressive periodontal disease associated with human immunodeficiency virus

Severe periodontal inflammation with generalized dental plaque accumulation, spontaneous and severe gingival bleeding, fungal infection, and interdental papillae necrosis are presented in a patient infected with human immunodeficiency virus (HIV). Bite-wing radiographs revealed a generalized horizontal alveolar bone loss of 7-8 millimetres in both arches. Erythematous patches were noted on the gingival mucosa in both jaws. DNA testing was performed to indentify the periodontopathogens. The patient had no signs or symptoms of acquired immunodeficiency syndrome. This case-report presents the massive periodontal destruction that occurred in a patient infected with HIV. Therefore, it is highly recommended that patients infected with HIV should be regularly monitored to aid in early detection and to provide proper management of periodontal inflammatory conditions to minimize its destruction.     

Rapidly progressive glomerulonephritis associated with rifampicin therapy for pulmonary tuberculosis

Two months after commencing continuous treatment with rifampicin, isoniazid, streptomycin and pyrazinamide for pulmonary tuberculosis a patient developed a nephrotic syndrome, acute nonoliguric renal failure and evidence of intravascular hemolysis. Renal biopsy revealed a severe crescentic nephritis with mild interstitial changes. The use of rifampicin has been associated with various renal abnormalities and this report documents the occurrence of a rapidly progressive crescentic glomerulonephritis presenting as nephrotic syndrome in a patient receiving continuous treatment with rifampicin.