case_images: PMC10351352_01
case_images: Light micrograph of renal specimen shows glomeruli with mesangial expansion and segmental endocapillary proliferation (PAS, A: x100, B: x200).
case_images: jrd-30-1-53-f1.jpg
case_images: PMC10351352_01_jrd-30-1-53-f1.jpg
case_images: F1
case_images: No crescentic lesions were observed (Figure 1).
case_images: (A, B) Initial magnetic resonance imaging (MRI) of the brain. The axial T2-weighted image (T2WI) (A) shows a large intra-axial heterogeneous mass in the left frontal lobe with perilesional edema. Note that the prominent hemorrhagic component in the mass and other remote lesions of both frontoparietal lobes are revealed in the axial susceptibility-weighted image (SWI) (B). No significant enhancement is seen. (C, D) Follow-up MRIs after four months of immunosuppressive treatment. Axial T2WI (C) and SWI (D) demonstrate decrease in mass size, perilesional edema, and peripheral hemosiderin rim formation, even in non-operated remote lesions. No new lesions were observed.
case_images: jrd-30-1-53-f2.jpg
case_images: PMC10351352_01_jrd-30-1-53-f2.jpg
case_images: F2
case_images: Brain MRI revealed a large intra-axial heterogeneous mass with a prominent hemorrhagic component, perilesional edema in the left frontal lobe, and remote lesions in both frontoparietal lobes (Figure 2A and 2B). Four months later, follow-up brain MRI showed a reduction in the size of mass, without new lesions (Figure 2C and 2D).
case_images: Histopathology from a biopsy of left frontal brain lesion shows (A) a necrotizing vasculitis with fibrinoid necrosis of vessel wall and (B) leukocytoclastic vasculitis with prominent neutrophil infiltration and adjacent nuclear debris in a perivascular area (H&E, A: x100, B: x400).
case_images: jrd-30-1-53-f3.jpg
case_images: PMC10351352_01_jrd-30-1-53-f3.jpg
case_images: F3
case_images: The brain biopsy showed necrotizing vasculitis of the small- and medium-sized arteries, leading to hemorrhages and leukocytoclastic vasculitis (Figure 3).