파종성 결핵에 동반된 IgA 신병증 1예

Abstract

Department of Pathology2, Hanyang University College of Medicine, Seoul, Korea The cause of IgA nephropathy is unknown, but a mesangial deposition of IgA immune complexes containing antigens from a putative pathogen might be involved in its pathogenesis. We report a case of IgA nephropathy associated with disseminated tuberculosis. A 32-year-old man was presented with sudden onset of edema of both lower legs. The chest X-ray revealed extensive active pulmonary tuberculosis in both lung fields. The abdominal CT, cystoscopy and IVP were compatible with renal tuberculosis and tuberculous cystitis. Besides, the colonoscopic findings with biopsy showed tuberculous colitis. The laboratory data revealed a positive culture for tuberculous bacilli from sputum, 2.7 g of 24-hour urinary protein, and microscopic hematuria. A renal biopsy showed mesangial and segmental endocapillary proliferative glomerulonephritis, consistent with IgA nephropathy. Intense positive stainings for IgA and C3 in the mesangium by Immunofluorescence microscopy. Electron microscopic examination demonstrates segmental endocapillary proliferation, necrosis and mesangiolysis with mild mesangial electron-dense deposits. Treatment with anti-tuberculous medications resulted in gradual disappearance of proteinuria and other various manifestations of the disseminated tuberculosis. Therefore we suggest that IgA nephropathy may be associated with active disseminated tuberculosis.