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Abstract: SA-PO892

A Case of Type II Cryoglobulinemic Membranoproliferative GlomerulonephritisAssociated with Marginal Zone B Cell Lymphoma

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Author

  • Patel, Pooja V., Mercy Fitzgerald Hospital, Darby, Pennsylvania, United States
Introduction

Cryoglobulinemia is rare. Renal involvement is seen some cases associated with type II cryoglobulinemia.

We present a case of type II Cryoglobulinemic MPGN associated with Marginal Zone B-cell Lymphoma and response to the treatment.

Case Description

A 74-year-old male with history of HTN, DM II, recent LE DVT presented to the hospital with worsening SOB, lower extremity edema, intermittent abdominal pain associated with nausea for 2 days. Upon arrival his BP was 168/79 mmHg. On exam, bibasilar crackles and +1 LE pitting edema. Labs revealed SCr 5.8 mg/dl (baseline 1.5 mg/dl). UA was positive for protein & RBC. Complements C3 and C4 were low. ANA was negative and RF level 1104. Cytology revealed positive cryoglobulin, Hep B core total and sIgG antibody positive with undetectable viral load. Hep C and HIV were negative. Immunofixation showed prominent IgM kappa.
Kidney biopsy revealed B-cell lymphoma associated type II cryoglobulinemic glomerulonephritis. Immunofluorescence studies revealed glomerulus immune deposits of IgM and Kappa. Omental mass biopsy showed Marginal zone B-cell lymphoma. He was started on Rituximab and Methylprednisolone. After 3 months of treatment, his renal function improved to 1.5 mg/dl. He developed rash after first few doses of Rituximab.

Discussion

Noninfectious type II cryoglobulinemic GN associated with marginal zone lymphoma is uncommon. Management
and prognosis is dependent on disease severity and treatment of underlying cancer.

Rash after Rituximab