case_images: PMC9966564_01
case_images: Renal biopsy revealing TMA and FSGS. (a) Light microscopy of the glomerulus with acute thrombotic occlusion in the capillary wall (horizontal arrow) and capillaries with double contours (vertical arrows; hematoxylin and eosin (H&E); original magnification 400x). (b) Light microscopy of the glomerulus with features of collapsing glomerulopathy including capillary collapse and epithelial enlargement and proliferation (asterisks; periodic acid/Schiff base (PAS); original magnification 400x). (c) Immunofluorescence microscopy for fibrin showing the glomerular segment with fibrin deposition in capillary walls (arrows; original magnification 400x). (d) Electron micrograph showing detached podocytes (P) with subepithelial deposition of loose matrix (asterisks) and capillary with mesangial interposition (arrow; original magnification 1500x).
case_images: CRIHEM2023-7803704.001.jpg
case_images: PMC9966564_01_CRIHEM2023-7803704.001.jpg
case_images: fig1
case_images: TMA as well as collapsing FSGS (Figure 1). The biopsy was negative for cast nephropathy, monoclonal immune deposition, and amyloid.
case_images: Bone marrow biopsy and peripheral blood flow cytometry revealing plasma cell leukemia. (a) Flow cytometry of peripheral blood demonstrates a discrete population of CD38 positive plasma cells with aberrant loss of CD19; this population of cells is also positive for CD138 and is lambda restricted. (b) Light microscopy of peripheral blood demonstrates leukemic plasma cells with a bizarre bilobed and multilobed nuclear phenotype (original magnification 100x). (c) Light microscopy of bone marrow biopsy demonstrates atypical plasma cells with similar bilobed nuclear morphology (arrows; original magnification 60x).
case_images: CRIHEM2023-7803704.002.jpg
case_images: PMC9966564_01_CRIHEM2023-7803704.002.jpg
case_images: fig2
case_images: A bone marrow biopsy was performed which in conjunction with peripheral blood flow cytometry was diagnostic for plasma cell leukemia with 10% circulating plasma cells (Figure 2).