case_images: PMC11810934_01
case_images: Timeline of patient diagnosis and treatment.
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case_images: f1
case_images: He sought care at our outpatient clinic, was diagnosed with "IgG4-RD," and subsequently admitted to our department ( Figure 1 ).
case_images: Bone marrow biopsy. (A) IgG (+) (x100); (B) IgG4 (+) (x200); (C) CD79alpha (+) (x200).
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case_images: Immunohistochemistry demonstrated hyperproliferation of mature lymphocytes and plasma cells, with CD138 (+, 5%-10%), CD38 (+, approximately 5% in hotspot areas), CD79alpha (+, 5%-10%), CD56 (+, few), CD3 (+, few), CD4 (+, few), CD8 (+, few), multiple myeloma oncogene-1 (-), IgA (+, individual), IgG (+, few), IgG4 (+, individual), IgM (+, individual), Lambda (+, few), Kappa (+, few), and Ki-67 (+, approximately 20%) ( Figure 2 ).
case_images: Biopsy of left cervical lymph node. (A) Partial closure of subcapsular sinus, few follicles in the subcapsular region and the center of the lymph node, and atrophy of some GCs under low magnification (x100); (B) CD34 (+, showing vascular hyperplasia penetrating GCs) (x200); (C) CD21 (+, showing shrinkage and destruction of the FDC network) (x100); (D) CD21 (+) (x200).
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case_images: f3
case_images: Renal puncture biopsy. (A, B) Hexamine silver and Masson staining showing immune complex deposition and thickened basement membrane, respectively; (C, D) IgA1 (++++) (x400). Findings are consistent with focal proliferative sclerosing IgA nephropathy with membranous nephropathy.
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case_images: f4
case_images: These findings suggested focal proliferative sclerosing IgA nephropathy (M1E1S1T1) with features of membranous nephropathy ( Figure 4 ).