case_images: PMC5546083_01
case_images: PMC5546083_02
case_images: Relationship between serum creatinine, WBC, and haemoglobin. Upon initial presentation to our hospital several months earlier, patient had normal laboratory values. At this admission the patient had leukocytosis, anemia, and rising creatinine values. Administration of methylprednisolone and rituximab (star) was associated with an initial rise in WBC count. Within several days leukocyte counts began to decline, most notably after the second rituximab infusion (two stars). Haemoglobin and creatinine levels also responded appropriately. At the outpatient clinic follow-up the patient received another two doses of rituximab. Laboratory testing continued to show improved WBC count, haemoglobin, and creatinine levels.
case_images: CRIRH2017-6484092.001.jpg
case_images: PMC5546083_02_CRIRH2017-6484092.001.jpg
case_images: fig1
case_images: Haemoglobin and haematocrit values gradually declined from admission values of 9.1 g/dL and 29.9% to 6.6 g/dL and 20% (Figure 1); schistocytes and target cells were identified on peripheral smear. Lab values, 5 months after hospitalization, revealed WBC 8.2k/muL, haemoglobin 12.8 g/dL, haematocrit 39.2%, platelets 210k/UL, BUN 22 mg/dL and creatinine 1.4 mg/dL, AST 23 IU/L, and ALT 16 IU/L (Figure 1).
case_images: Full thickness fibrinoid necrosis of the vessels with surrounding interstitial necrosis.
case_images: CRIRH2017-6484092.002.jpg
case_images: PMC5546083_02_CRIRH2017-6484092.002.jpg
case_images: fig2
case_images: Fibrinogen staining showed crescents and necrosis of an artery (Figures 2-4).
case_images: Tubular atrophy with dense lymphocytic inflammatory infiltrate and interstitial fibrosis.
case_images: CRIRH2017-6484092.003.jpg
case_images: PMC5546083_02_CRIRH2017-6484092.003.jpg
case_images: fig3
case_images: Fibrinogen staining showed crescents and necrosis of an artery (Figures 2-4).
case_images: Fibrinogen staining shows cellular crescents (a) and necrosis of an artery (b).
case_images: CRIRH2017-6484092.004.jpg
case_images: PMC5546083_02_CRIRH2017-6484092.004.jpg
case_images: fig4
case_images: Fibrinogen staining showed crescents and necrosis of an artery (Figures 2-4).