Case reportMulticentric Castleman's disease associated with glomerular microangiopathy and MPGN-like lesion: does vascular endothelial cell-derived growth factor play causative or protective roles in renal injury?
Section snippets
Case report
A 52-year-old Japanese man presented with fever spikes, generalized fatigue, and anorexia. Two months before admission, he received cefmetazole, minocycline, and levofloxacin for presumed diagnosis of lymphadenitis because he had cervical lymph node swelling. However, the patient's fever continued, the fatigue progressed, and generalized edema developed, although proteinuria was absent. The patient was admitted for the evaluation of fever of unknown origin in association with generalized lymph
Discussion
The current case highlights the renal involvement of multicentric Castleman's disease that is characterized by MPGN-like lesions, mesangiolytic glomerulonephritis, and prominent glomerular microangiopathy. Unlike primary MPGN, there were no immune complexes and no electron-dense deposits in the glomeruli as seen by immunofluorescence and electron microscopic studies and diffuse widening of subendothelial space. These histologic features were seen also in POEMS (polyneuropathy, organomegaly,
Acknowledgements
The authors thank Mrs Hashimoto and Mrs Saito for technical assistance with electron microscopy.
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