case_images: PMC4294451_01
case_images: Clinical course after the initiation of bucillamine therapy.
case_images: cnd-0005-0030-g01.jpg
case_images: PMC4294451_01_cnd-0005-0030-g01.jpg
case_images: F1
case_images: After the patient's admission, bucillamine was stopped and her clinical course was monitored (fig. 1). The patient underwent a 3-day course of methylprednisolone 0.5 g/day twice, which was followed by oral prednisolone 25 mg/day (fig. 1).
case_images: Light microscopy findings of the renal biopsy. a Mild intracapillary proliferation and small cellular crescents. Periodic acid Schiff staining. x40. b Global cellular crescent. Periodic acid methenamine silver staining. x100. IF findings: fine granular staining of IgG (c), IgG1 (d), IgG2 (e), IgG3 (f), and IgG4 (g) on the glomerular capillary loop.
case_images: cnd-0005-0030-g02.jpg
case_images: PMC4294451_01_cnd-0005-0030-g02.jpg
case_images: F2
case_images: On light microscopy, slight endocapillary proliferation with inflammatory cell infiltration was observed (fig. 2a), and crescent formation was seen in 7 glomeruli (fig. 2a, b). IF study revealed fine granular deposits of immunoglobulin G (IgG) (3+; fig. 2c), C3c (3+), and C1q (1+) along the capillary walls. Staining for IgG subclass showed positive staining for IgG1 (3+), IgG2 (1-2+), IgG3 (1-2+), and IgG4 (3+) (fig. 2d-g).
case_images: EM findings. a Subepithelial electron-dense deposits (white arrow heads). Original magnification x6,000. b Extensive foot process effacement, microvillus transformation, and vacuolar degeneration of podocytes. Original magnification x2,000.
case_images: cnd-0005-0030-g03.jpg
case_images: PMC4294451_01_cnd-0005-0030-g03.jpg
case_images: F3
case_images: Electron microscopy (EM) showed segmental subepithelial deposits along the glomerular basement membrane (fig. 3a) with extensive foot process effacement, microvillus transformation, and vacuolar degeneration of podocytes (fig. 3b).