Abstract: TH-PO0511
An Unusual Case of Hyperpigmentation in a Patient with Crescentic IgAN Treated with Cyclophosphamide
Session Information
- Glomerular Diseases: IgAN, IgA Vasculitis, and More
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Yeon, Wenxiang, Changi General Hospital, Singapore, Singapore
- Roy, Debajyoti M., Changi General Hospital, Singapore, Singapore
Introduction
Crescentic IgA nephropathy is a severe, rapidly progressive form of IgA nephropathy often requiring aggressive immunosuppression with pulse steroids and cyclophosphamide.
Case Description
47-year-old Indian gentleman with hypertension, hyperlipidaemia and well controlled Type II diabetes mellitus underwent a renal biopsy for nephritic syndrome. Renal biopsy diagnosed crescentic IgA glomerulonephritis. He was treated with intravenous (IV) methylprednisolone 500mg daily for 3 days and subsequently started on IV cyclophosphamide 1g monthly with a tapering dose of oral prednisolone. He had undergone 3 cycles of IV cyclophosphamide treatment before he was referred to the dermatology service for progressive skin darkening on the trunk, back and limbs. The skin changes are non-pruritic and not painful. He is otherwise well but was bothered by the cosmesis of the dyspigmentation.
On examination, there are hyperpigmented well demarcated dark brown macules and patches with a rippled and reticulated appearance distributed symmetrically over the abdomen, back, upper limbs and lower limbs (Figure 1). There is sparing of the face, neck and flexural surfaces. The oral mucosa was unaffected and there was no melanonychia. A punch biopsy from the affected skin was performed.
Histopathological examination of the skin biopsy sample revealed increased basal keratinocyte pigmentation without an associated increase in the number of melanocytes. A diagnosis of cyclophosphamide induced hyperpigmentation was made.
The patient was advised on the use of emollients and minimizing unprotected sun exposure. He opted to continue IV cyclophosphamide and completed 6 cycles of IV cyclophosphamide. During his last review, 6 months after stopping cyclophosphamide, his dyspigmentation resolved completely.
Discussion
Clinicians should be aware of the potential occurrence of cyclophosphamide-induced hyperpigmentation which may be cosmetically distressing but fortunately usually resolves spontaneously after discontinuation.
Figure 1- Dark brown macules and patches with a rippled and reticulated appearance over the abdomen, lower back, and limbs.