case_images: PMC4676346_01
case_images: Right pleural effusion with associated basilar atelctasis.
case_images: jocmr-08-047-g001.jpg
case_images: PMC4676346_01_jocmr-08-047-g001.jpg
case_images: F1
case_images: Chest X-ray done in the ED revealed right pleural effusion, which was confirmed by CT scan (Fig. 1, 2).
case_images: Moderate right pleural effusion.
case_images: jocmr-08-047-g002.jpg
case_images: PMC4676346_01_jocmr-08-047-g002.jpg
case_images: F2
case_images: Chest X-ray done in the ED revealed right pleural effusion, which was confirmed by CT scan (Fig. 1, 2).
case_images: Kidney function during hospitalization. This graph demonstrates the progressive rise in BUN and creatinine during hospitalization until a peak of 10.2 where hemodialysis was started.
case_images: jocmr-08-047-g003.jpg
case_images: PMC4676346_01_jocmr-08-047-g003.jpg
case_images: F3
case_images: Meanwhile, the patient's kidney function continued to deteriorate with an increase in serum creatinine to 5.31 on day 7 despite adequate medical management (Fig. 3).
case_images: LM - macrophage infiltration.
case_images: jocmr-08-047-g004.jpg
case_images: PMC4676346_01_jocmr-08-047-g004.jpg
case_images: F4
case_images: Results came back as diffuse endocapillary proliferative and exudative glomerulonephritis with infiltrating monocytes/macrophages 3+ and neutrophils 1+ on light microscopy (Fig. 4).
case_images: EM - subendothelial deposits.
case_images: jocmr-08-047-g005.jpg
case_images: PMC4676346_01_jocmr-08-047-g005.jpg
case_images: F5
case_images: Electron microscopy revealed global subendothelial electron dense deposits consisting of mixed cryoglobulin (IgG/IgM) and C3, segmental subepithelial deposits and intracapillary fibrillar fibrin (Fig. 5).
case_images: IF - FIBRIN.
case_images: jocmr-08-047-g006.jpg
case_images: PMC4676346_01_jocmr-08-047-g006.jpg
case_images: F6
case_images: Immunofluorescence (IF) revealed global glomerular capillary wall positivity for IgG, trace IgM, 2+ C3, 1-2+ C1, 3+ kappa and trace lambda (Fig. 6, 7).
case_images: IF - IgG.
case_images: jocmr-08-047-g007.jpg
case_images: PMC4676346_01_jocmr-08-047-g007.jpg
case_images: F7
case_images: Immunofluorescence (IF) revealed global glomerular capillary wall positivity for IgG, trace IgM, 2+ C3, 1-2+ C1, 3+ kappa and trace lambda (Fig. 6, 7).