Abstract: PO1946
Insidious Granulomatous Interstitial Nephritis (GIN) in a Patient with a History of Diffuse Large B Cell Lymphoma (DLBCL)
Session Information
- Renal Pathology: From Laboratory to Bedside
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1600 Pathology and Lab Medicine
Authors
- Suehiro, Yohei, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Ueda, Hiroyuki, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Nobayashi, Hiroki, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Ueda, Risa, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Maruyama, Yukio, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Tsuboi, Nobuo, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
Introduction
GIN has diverse etiology as infections, vasculitis, sarcoidosis, and lymphoma. These diseases can occur in the same patient, making diagnosis and treatment decisions challenging. Here, we report a case of GIN with a fever that developed after a long period since the complete remission (CR) of DLBCL.
Case Description
A 46-year-old man was admitted to our hospital with malaise, dyspnea, and severe renal failure (RF). Twenty years before the admission, he was diagnosed with DLBCL. After 4 years of treatments, he achieved CR. Thirteen years after CR, he presented to our hospital with a persistent fever. At this time, impaired renal function (serum [s] Cr 1.8 mg/dL) was noted. FDG-PET CT showed uptake in the enlarged lymph nodes (LN) around the pancreas and in both kidneys. Biopsy of the LN revealed multiple epithelioid granulomas and no evidence of recurrence of DLBCL, and his fever was resolved spontaneously. Two years later, he was admitted due to advanced RF (sCr 11.8 mg/dL), and hemodialysis (HD) was initiated. Both kidneys were atrophic on CT scan, whereas they still showed intense uptake on Ga scintigraphy. The renal biopsy showed diffuse GIN, but recurrence of DLBCL, sarcoidosis, and vasculitis was denied. Examinations for Tuberculosis (TB) were only positive for the interferon-gamma release assays (IGRAs) and negative for renal stains, systemic cultures, and image studies for lung TB. Anti-TB therapy was administered for his persistent fever that recurred after hospitalization. After the initiation of the anti-TB treatment, his fever gradually resolved, and he has been well, although he cannot withdraw HD.
Discussion
The course of our case suggests that the GIN was induced by TB infection, although our patient did not show typical features of systemic TB except for positive IGRAs. There has been an increase in the number of cases of TB infection diagnosed following GIN, which is presented not with the typical features of classical renal TB but with a more insidious form (Oliveria et al., Clin Kidney J 2017). These cases are often diagnosed later and may associate with a poor prognosis. Our case suggests that anti-TB therapy should be considered for patients with IGRAs-positive GIN after excluding other etiologies of GIN, even without the other diagnostic evidence of systemic TB.