case_images: PMC11398963_01
case_images: The histology and molecular findings from this patient's first biopsy showing severe plasma cell-rich rejection. (a, b) There are abundant plasma cells infiltrating (blue arrow in (a)) the renal cortex with marked tubulitis (black arrows in (b)) ((a) hematoxylin and eosin stain; (b) periodic acid-Schiff stain; magnification x200). (c) Rejection phenotype from the molecular microscopy diagnostic report showing severe T cell-mediated rejection.
case_images: CRIT2024-9226321.001.jpg
case_images: PMC11398963_01_CRIT2024-9226321.001.jpg
case_images: fig1
case_images: TCMR, Grade IIA, plasma cell-rich variant (PCAR). There were diffuse and abundant polyclonal plasma cells infiltrating the renal parenchyma with marked tubulitis and focal endarteritis with mild interstitial fibrosis with tubular atrophy (Figure 1).
case_images: The histology and molecular findings from this patient's follow-up biopsy showing persistent plasma cell-rich rejection. (a, b) There are abundant plasma cells infiltrating the renal cortex with marked tubulitis ((a) hematoxylin and eosin stain; (b) periodic acid-Schiff stain; magnification x400). (c) Rejection phenotype from the molecular microscopy diagnostic report showing moderate T cell-mediated rejection.
case_images: CRIT2024-9226321.002.jpg
case_images: PMC11398963_01_CRIT2024-9226321.002.jpg
case_images: fig2
case_images: A follow-up biopsy after 2 months demonstrated persistent plasma cell infiltration and marked tubulitis (Figure 2) with increased interstitial fibrosis with tubular atrophy.
case_images: The histology and molecular findings from this patient's follow-up biopsy after bortezomib treatment showing no rejection. (a, b) There are normal-appearing renal cortex with no inflammation ((a) hematoxylin and eosin stain; (b) periodic acid-Schiff stain; magnification x200). (c) Rejection phenotype from the molecular microscopy diagnostic report showing no rejection.
case_images: CRIT2024-9226321.003.jpg
case_images: PMC11398963_01_CRIT2024-9226321.003.jpg
case_images: fig3
case_images: The second follow-up biopsy in 4 months showed a significant treatment effect with complete resolution of interstitial inflammation, no tubulitis, and markedly decreased chronicity (Figure 3).