Abstract: TH-PO0531
A Challenging Case of IgAN and Vasculitis Complicating Nivolumab Therapy for Hodgkin Lymphoma
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
- Memar, Shadi, Pennsylvania Hospital, Philadelphia, Pennsylvania, United States
- Kim, Yejin Andrea, Pennsylvania Hospital, Philadelphia, Pennsylvania, United States
- Sabbouh, Toni, Pennsylvania Hospital, Philadelphia, Pennsylvania, United States
Introduction
Immune checkpoint inhibitor (ICI)-associated renal injury often manifests as acute tubulointerstitial nephritis; however, IgA nephropathy is an increasingly recognized complication of PD-1 inhibition. Severity varies, but there are generally favorable renal outcomes with corticosteroids and discontinuation of offending medications. Distinguishing ICI-induced from paraneoplastic IgA disease is difficult, as Hodgkin lymphoma itself has been associated with IgA vasculitis and nephropathy. We present a case of IgA vasculitis and nephropathy in a woman receiving nivolumab for Hodgkin lymphoma with subsequent cancer recurrence.
Case Description
A 40-year-old female with Hodgkin lymphoma treated with cyclophosphamide/vincristine, now on brentuximab-nivolumab, developed a diffuse rash. She was referred to nephrology for nephrotic syndrome and microscopic hematuria with a urine protein creatinine ratio (UPCR) of 26 g/g and preserved renal function. Skin biopsy showed leukocytoclastic vasculitis with IgA-mediated features. Kidney biopsy demonstrated IgA-dominant endocapillary hypercellular glomerulonephritis with minimal interstitial fibrosis. Electron microscopy showed segmental podocyte effacement. Nivolumab was discontinued, and corticosteroids and losartan were initiated. UPCR improved to 9.4 g/g 4 months later, showing partial response to therapy. During that time, she had recurrence of her cancer. After stem cell transplantation (SCT), she had near resolution of proteinuria with a UPCR of 0.76 g/g (Figure 1).
Discussion
The concurrent cutaneous vasculitis and glomerulonephritis in this case supports systemic IgA vasculitis rather than IgA nephropathy. The challenge lies in attributing the IgA vasculitis to nivolumab versus the underlying malignancy, as lymphoma recurrence raises the possibility of paraneoplastic pathogenesis and improvement in proteinuria after SCT favors a paraneoplastic mechanism, although we are unable to rule out nivolumab involvement. This case highlights the importance of screening for proteinuria and hematuria in patients who are receiving ICIs and introduces the clinical dilemma when ICI discontinuation due to nephrotoxicity compromises oncologic outcomes.