Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature
Abstract Background Multicentric Castleman’s disease is a life-threatening disorder involving a systemic inflammatory response and multiple organ failure caused by the overproduction of interleukin-6. Although renal complications of Castleman’s disease include AA amyloidosis, thrombotic microangiopa...
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-021-02423-w |
| _version_ | 1818864852986232832 |
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| author | Ryosuke Saiki Kan Katayama Yosuke Hirabayashi Keiko Oda Mika Fujimoto Tomohiro Murata Ayako Nakajima Kaoru Dohi |
| author_facet | Ryosuke Saiki Kan Katayama Yosuke Hirabayashi Keiko Oda Mika Fujimoto Tomohiro Murata Ayako Nakajima Kaoru Dohi |
| author_sort | Ryosuke Saiki |
| collection | DOAJ |
| description | Abstract Background Multicentric Castleman’s disease is a life-threatening disorder involving a systemic inflammatory response and multiple organ failure caused by the overproduction of interleukin-6. Although renal complications of Castleman’s disease include AA amyloidosis, thrombotic microangiopathy, and membranoproliferative glomerulonephritis, membranous nephropathy is relatively rare. We experienced a case of secondary membranous nephropathy associated with Castleman’s disease. Case presentation The patient was a 43-year-old Japanese man who had shown a high zinc sulfate value in turbidity test, polyclonal hypergammaglobulinemia, anemia, and proteinuria. A physical examination revealed diffuse lymphadenopathy, an enlarged spleen and papulae of the body trunk. A skin biopsy of a papule on the patient’s back showed plasma cells in the perivascular area and he was diagnosed with multicentric Castleman’s disease, plasma cell variant. Kidney biopsy showed the appearance of bubbling in the glomerular basement membranes in Periodic acid methenamine silver stain and electron microscopy revealed electron dense deposits within and outside the glomerular basement membranes. Since immunofluorescence study showed predominant granular deposition of IgG1 and IgG2, he was diagnosed with secondary membranous nephropathy associated with Castleman’s disease. He was initially treated with prednisolone alone, however his biochemical abnormalities did not improve. After intravenous tocilizumab (700 mg every 2 weeks) was started, his C-reactive protein elevation, anemia, and polyclonal gammopathy improved. Furthermore, his urinary protein level declined from 1.58 g/gCr to 0.13 g/gCr. The prednisolone dose was gradually tapered, then discontinued. He has been stable without a recurrence of proteinuria for more than 6 months. Conclusions Tocilizumab might be a treatment option for secondary membranous nephropathy associated with Castleman’s disease. |
| first_indexed | 2024-12-19T10:38:15Z |
| format | Article |
| id | doaj.art-01c73b9e96d045208ad6de8923fa2c7f |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-19T10:38:15Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-01c73b9e96d045208ad6de8923fa2c7f2022-12-21T20:25:31ZengBMCBMC Nephrology1471-23692021-06-012211610.1186/s12882-021-02423-wMembranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literatureRyosuke Saiki0Kan Katayama1Yosuke Hirabayashi2Keiko Oda3Mika Fujimoto4Tomohiro Murata5Ayako Nakajima6Kaoru Dohi7Department of Cardiology and Nephrology, Mie University Graduate School of MedicineDepartment of Cardiology and Nephrology, Mie University Graduate School of MedicineDepartment of Cardiology and Nephrology, Mie University Graduate School of MedicineDepartment of Cardiology and Nephrology, Mie University Graduate School of MedicineDepartment of Cardiology and Nephrology, Mie University Graduate School of MedicineDepartment of Cardiology and Nephrology, Mie University Graduate School of MedicineCenter for Rheumatic Diseases, Mie University HospitalDepartment of Cardiology and Nephrology, Mie University Graduate School of MedicineAbstract Background Multicentric Castleman’s disease is a life-threatening disorder involving a systemic inflammatory response and multiple organ failure caused by the overproduction of interleukin-6. Although renal complications of Castleman’s disease include AA amyloidosis, thrombotic microangiopathy, and membranoproliferative glomerulonephritis, membranous nephropathy is relatively rare. We experienced a case of secondary membranous nephropathy associated with Castleman’s disease. Case presentation The patient was a 43-year-old Japanese man who had shown a high zinc sulfate value in turbidity test, polyclonal hypergammaglobulinemia, anemia, and proteinuria. A physical examination revealed diffuse lymphadenopathy, an enlarged spleen and papulae of the body trunk. A skin biopsy of a papule on the patient’s back showed plasma cells in the perivascular area and he was diagnosed with multicentric Castleman’s disease, plasma cell variant. Kidney biopsy showed the appearance of bubbling in the glomerular basement membranes in Periodic acid methenamine silver stain and electron microscopy revealed electron dense deposits within and outside the glomerular basement membranes. Since immunofluorescence study showed predominant granular deposition of IgG1 and IgG2, he was diagnosed with secondary membranous nephropathy associated with Castleman’s disease. He was initially treated with prednisolone alone, however his biochemical abnormalities did not improve. After intravenous tocilizumab (700 mg every 2 weeks) was started, his C-reactive protein elevation, anemia, and polyclonal gammopathy improved. Furthermore, his urinary protein level declined from 1.58 g/gCr to 0.13 g/gCr. The prednisolone dose was gradually tapered, then discontinued. He has been stable without a recurrence of proteinuria for more than 6 months. Conclusions Tocilizumab might be a treatment option for secondary membranous nephropathy associated with Castleman’s disease.https://doi.org/10.1186/s12882-021-02423-wCastleman’s disease - membranous nephropathyProteinuria - tocilizumab |
| spellingShingle | Ryosuke Saiki Kan Katayama Yosuke Hirabayashi Keiko Oda Mika Fujimoto Tomohiro Murata Ayako Nakajima Kaoru Dohi Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature BMC Nephrology Castleman’s disease - membranous nephropathy Proteinuria - tocilizumab |
| title | Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature |
| title_full | Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature |
| title_fullStr | Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature |
| title_full_unstemmed | Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature |
| title_short | Membranous nephropathy associated with multicentric Castleman’s disease that was successfully treated with tocilizumab: a case report and review of the literature |
| title_sort | membranous nephropathy associated with multicentric castleman s disease that was successfully treated with tocilizumab a case report and review of the literature |
| topic | Castleman’s disease - membranous nephropathy Proteinuria - tocilizumab |
| url | https://doi.org/10.1186/s12882-021-02423-w |
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