case_images: PMC3975747_01
case_images: The burned skin.
case_images: cru-0004-0031-g01.jpg
case_images: PMC3975747_01_cru-0004-0031-g01.jpg
case_images: F1
case_images: The skin showed fuscous, slight exudation, bleeding cracks, mild scaling and itch during the treatment process (fig. 1).
case_images: Renal pathology showed diffuse proliferative MPGN-like IgAN. a Slight lobular accentuation, intracapillary hypercellularity in the glomerular tuft, extensive mesangial involvement and capillary wall thickening. Periodic acid-Schiff staining, x400. b Segmental duplication of glomerular basement membrane, thickening of glomerular capillary wall density, glomerular mesangial and subendothelial deposits. Periodic acid-silver metheramine staining, x400. c Identification of discrete glomerular subendothelial and mesangial deposits. Masson trichrome staining, x400. d Highly positive staining for IgA in a broken, wide and band-like pattern with some coarse granularity areas along capillary loops and mesangium. Segmental IgA staining were also observed in the mesangium. Immunofluorescence, x400. e Highly positive staining for C3 in a coarse granular pattern along peripheral glomerular capillaries. Immunofluorescence, x400. f Ultrastructural appearance during outward migration of mesangial cells, infiltration of inflammatory cells, margination of endothelial cells along the inside of capillary walls, and interposition between endothelium and glomerular basement membrane of these cells. Glomerular visceral epithelial cell foot process showed effacement. Numerous large discrete electron-dense osmiophilic deposits within the subendothelium, mesangium and segmental subepithelium were present. Uranyl acetate and lead citrate, x3,000.
case_images: cru-0004-0031-g02.jpg
case_images: PMC3975747_01_cru-0004-0031-g02.jpg
case_images: F2
case_images: Neither tubular atrophy nor interstitial fibrosis was found, as shown in figure 2a-c. Immunofluorescence revealed IgA (3+), trace IgM, C3 (3+), IgG (-), C4 (-) and C1q (-) in a coarse granular pattern with mesangial and capillary distribution (fig. 2d, e), and inconspicuous staining for IgM along the glomerular capillary walls in a granular pattern. In addition, this patient showed negative staining of HBsAg and HBcAg. The thickened capillary wall was composed of basement membrane-like materials, interposed mesangial cells, and electron-dense immune-type deposits (fig. 2f).