著者

Minami Suzuki Yuta Sekiguchi Masato Sasaki Shunsuke Inaba Sakino Oyama Yuichi Inoue Masahiro Warabi Kenichi Ohashi Seiji Inoshita

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.61, no.19, pp.2925-2929, 2022-10-01 (Released:2022-10-01)

参考文献数

32

被引用文献数

11

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The extent of rare side effects of mRNA vaccines for coronavirus disease 2019 (COVID-19) remains unclear. Several cases of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) following COVID-19 vaccination have been reported. We herein report a 72-year-old man who presented with a fever after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. He was diagnosed with acute kidney injury due to myeloperoxidase-ANCA-associated vasculitis and was treated with intermittent hemodialysis, high-dose prednisolone, and intravenous rituximab. His general symptoms and renal impairment subsequently improved. When systemic symptoms are prolonged or renal abnormalities appear after COVID-19 vaccination, the possibility of AAV should be considered.

著者

Makoto Fukuda Naoki Sawa Daisuke Ikuma Yuki Oba Hiroki Mizuno Masayuki Yamanouchi Akinari Sekine Eiko Hasegawa Tatsuya Suwabe Junichi Hoshino Kei Kono Keiichi Kinowaki Kenichi Ohashi Hiromichi Tamaki Motoaki Miyazono Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.62, no.1, pp.81-85, 2023-01-01 (Released:2023-01-01)

参考文献数

9

被引用文献数

2 3

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A 43-year-old Japanese woman with rheumatoid arthritis treated by infliximab and methotrexate for 11 years was admitted for proteinuria and purpura. A kidney biopsy revealed endothelial damage-dominant nephritis with IgA deposition. Infliximab and methotrexate were discontinued, and tocilizumab was started; however, proteinuria persisted. Therefore, tocilizumab was discontinued, and oral prednisolone and methylprednisolone pulse therapy were administered. After 6 months, urinary protein was less than 0.1 g/day, and purpura subsided. To our knowledge, this is the first case of endothelial damage-dominant nephritis related to IgA vasculitis involving the skin and kidney after long-term use of infliximab and methotrexate.

著者

Atsuhiko Suenaga Naoki Sawa Daisuke Ikuma Yuki Oba Akinari Sekine Masayuki Yamanouchi Eiko Hasegawa Hiroki Mizuno Tatsuya Suwabe Kei Kono Yukako Shintani-Domoto Keiichi Kinowaki Kenichi Ohashi Yoshiyuki Suzuki Motoaki Miyazono Tamiko Takemura Yutaka Yamaguchi Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1121-22, (Released:2023-02-01)

参考文献数

8

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We performed 3 kidney biopsies in a 71-year-old man. At the first biopsy, we made the diagnosis of immunoglobulin G4 (IgG4)-related interstitial nephritis characterized by the simultaneous presence of IgG4-positive plasma cells and characteristic fibrosis with a bird's-eye pattern. At the second biopsy, rather than finding fibrosis as a post-inflammatory scar, we noted that steroid treatment had caused the simultaneous disappearance of IgG4-positive plasma cells and fibrosis and had restored the normal tubular structure. The third biopsy showed the recurrence of the disease with inflammatory cells accompanied by fibrosis. These findings suggest that IgG4-positive plasma cells and fibrosis occur simultaneously.

著者

Atsuhiko Suenaga Naoki Sawa Katsuyuki Miki Takayoshi Yokoyama Yasuo Ishii Hiroki Mizuno Daisuke Ikuma Yuki Oba Akinari Sekine Masayuki Yamanouchi Eiko Hasegawa Tatsuya Suwabe Kei Kono Keiichi Kinowaki Kenichi Ohashi Kazuho Honda Motoaki Miyazono Yuki Nakamura Yoshifumi Ubara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0813-22, (Released:2023-02-01)

参考文献数

16

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We experienced a 36-year-old man with lupus nephritis and antiphospholipid syndrome (APS) who received a donor kidney from his father. Twenty-two months after transplantation, at a time of poor adherence to immunosuppressants and warfarin, the patient developed sudden graft loss due to hemolytic uremic syndrome with rapid deterioration of renal function, thrombocytopenia, and hemolytic anemia. A kidney biopsy showed thrombotic microangiopathy (TMA) related to platelet thrombus formation; however, there was no recurrence of lupus and no findings suggestive of post-transplant rejection, so acute TMA associated with APS was thought to be the cause of the graft loss. This case highlights the importance of instructing patients with lupus nephritis to adhere to treatment with warfarin, a therapeutic drug for APS.

著者

Toshiharu Ueno Koichi Kikuchi Ryo Hazue Koki Mise Keiichi Sumida Noriko Hayami Tatsuya Suwabe Junichi Hoshino Naoki Sawa Kenji Arizono Shigeko Hara Kenmei Takaichi Takeshi Fujii Kenichi Ohashi Yoshifumi Ubara

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.20, pp.2993-2999, 2016-10-15 (Released:2016-10-15)

参考文献数

13

被引用文献数

1 3

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A 58-year-old man was referred to our institution for an evaluation of nephrotic range proteinuria. Renal biopsy showed a marked expansion of the mesangial matrix and thickening of glomerular basement membrane (GBM) in periodic acid-silver methenamine (PAM). Immunofluorescence (IF) revealed strong staining for the monoclonal kappa light chain. EM demonstrated massive subendothelial and mesangial dense deposits. As a result, light chain deposition disease (LCDD) was diagnosed. Melphalan and prednisolone (MP) therapy was started, which was continued for 10 years with minimal complications. Serial evaluations of renal histology revealed the resolution of nodular lesions and the glomeruli became nearly normal. MP therapy can therefore be an effective therapeutic option for LCDD if it is continued over the long term.