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      Proliferative glomerulonephritis and mantle cell lymphoma: a rare association

      case-report

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          Abstract

          Renal involvement in mantle cell lymphoma (MCL) is rare. We present the case of a man followed for MCL presented with acute kidney injury and positive antineutrophil cytoplasmic antibody (ANCA) type anti proteinase 3 (PR3). He was treated as for a rapidly progressing glomerulonephritis with cyclophosphamide and methylprednisolone followed by oral prednisone. Renal biopsy revealed diffuse endocapillary proliferation and segmental extracapillary proliferation in four glomeruli. Immunohistochemistry confirmed the renal invasion of lymphomatous cells. He started improving his renal function shortly after starting treatment. The coexistence of renal MCL infiltration, extracapillary proliferation and ANCA positive is exceptional.

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          Kidney involvement in leukemia and lymphoma.

          Randy Luciano, Ursula Brewster (2014)
          Leukemia and lymphoma are hematologic malignancies that can affect any age group. Disease can be aggressive or indolent, often with multiorgan system involvement. Kidney involvement in leukemia and lymphoma can be quite extensive. Acute kidney injury (AKI) is quite prevalent in these patients, with prerenal and acute tubular necrosis being the most common etiologies. However other prerenal, intrinsic, and obstructive etiologies are possible. AKI can be a direct effect of the malignancy, a complication of the malignancy, or the consequence or side effect of chemotherapy. Nephrotic syndrome and glomerulonephritis, often presenting without overt kidney failure, have also been seen in all forms of leukemia and lymphoma. Lastly, the direct effects of the malignancy and complications from the tumor often result in numerous electrolyte disturbances and acid-base disorders, with life-threatening consequences if left untreated.
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            Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies.

            Hyon K Choi, Peter Lamprecht, John Niles … (2000)
            To report a potentially important limitation of antineutrophil cytoplasmic antibody (ANCA) testing: positive results in patients with subacute bacterial endocarditis (SBE). We describe 3 patients with SBE who presented with features mimicking ANCA-associated vasculitis (AAV) and positive findings on tests for cytoplasmic ANCA (cANCA) by indirect immunofluorescence and for anti-proteinase 3 (anti-PR3)antibodies by antigen-specific enzyme-linked immunosorbent assay (ELISA). We also reviewed the published literature describing infectious diseases with (misinterpreted) positive ANCA results through a Medline search of English-language articles published between 1966 and January 1999. These previously reported cases were reinterpreted using an ANCA scoring system that combines the findings of immunofluorescence and antigen-specific ELISA testing. We are now aware of a total of 7 cases of SBE with positive cANCA and anti-PR3 antibodies. We are not aware of any cases of SBE associated with antimyeloperoxidase/perinuclear ANCA. Clinical manifestations mimicking AAV included glomerulonephritis, purpura, epistaxis, or sinus symptoms in 6 of the patients. Streptococcal species were identified in 5 patients, and cardiac valvular abnormalities were demonstrated in 6. All patients except 1, who died of a complication of SBE, recovered with antibiotic therapy. Findings of tests for anti-PR3/ cANCA antibodies may be positive in patients with SBE. When encountering ANCA positivity in patients suspected of having systemic vasculitis, physicians should take appropriate steps to rule out infectious diseases, including SBE, before committing the patient to long-term, aggressive immunosuppressive therapy.
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              Antineutrophil cytoplasmic antibody-positive pauci-immune glomerulonephritis associated with mantle cell lymphoma

              Kana N. Miyata, Nazia A. Siddiqi, Lawrence P. Kiss … (2017)
              Renal involvement in non-Hodgkin lymphoma, especially mantle cell lymphoma (MCL) is rare. A 77-year-old man presented with acute kidney injury (AKI), which rapidly progressed to dialysis dependence. Kidney biopsy revealed patchy B-cell lymphocytic aggregates in the interstitium, which were positive for cyclin D1, consistent with atypical CD5-negative MCL as confirmed by the detection of translocation t(11;14) by FISH. Crescents were noted in 3 of 26 glomeruli; while PR-3 antineutrophil cytoplasmic antibody (ANCA) positivity and negative immunofluorescence suggested an additional pauci-immune (rapidly progressive) glomerulonephritis pattern of injury. Patient received chemotherapy (cyclophosphamide, vincristine, and prednisone), which improved his renal function and allowed for discontinuation of hemodialysis. However, he died from pulmonary hemorrhage 8 months after initial presentation. This is the first reported case of a patient with coexistence of renal MCL infiltration and ANCA-positive pauci-immune glomerulonephritis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Case Rep
                Journal ID (iso-abbrev): BMJ Case Rep
                Journal ID (hwp): bmjcr
                Journal ID (publisher-id): bmjcasereports
                Title: BMJ Case Reports
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 1757-790X
                Publication date Collection: 2021
                Publication date (Electronic): 5 February 2021
                Publication date PMC-release: 5 February 2021
                Volume: 14
                Issue: 2
                Electronic Location Identifier: e238153
                Affiliations
                [1 ]departmentInternal Medecine Department , Charles Nicolle Hospital , Bab Saadoun, Tunis, Tunisia
                [2 ]departmentResearch Laboratory of Renal Pathology LR00SP01 , Charles Nicolle Hospital , Bab Saadoun, Tunis, Tunisia
                [3 ]departmentNephrology department , University Hospital Center Mongi Slim , La Marsa, Tunis, Tunisia
                Author notes
                [Correspondence to ] Dr Soumaya Chargui; chargui.souma@ 123456yahoo.fr
                Author information
                http://orcid.org/0000-0001-5717-3875
                Article
                Publisher ID: bcr-2020-238153
                DOI: 10.1136/bcr-2020-238153
                PMC ID: 7871245
                PubMed ID: 33547121
                SO-VID: 5d432648-1704-4838-a802-8a7257252f0f
                Copyright © © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 30 December 2020
                Categories
                Subject: Case Report
                Subject: 1506
                Subject: 495
                Subject: 498
                Subject: 532
                Subject: 547
                Custom metadata
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                Keywords: malignant and benign haematology,acute renal failure,vasculitis
                Data availability:
                Keywords: malignant and benign haematology, acute renal failure, vasculitis

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