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Images in rheumatology
IgG4-related tubulointerstitial nephritis
  1. Meng-Ko Tsai1,2,3,
  2. Yen-Lin Chen4,
  3. Hsiang-Cheng Chen1,5,
  4. Feng-Cheng Liu1,
  5. Deh-Ming Chang1,6,
  6. Chun-Chi Lu1
  1. 1 Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  2. 2 Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
  3. 3 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
  4. 4 Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  5. 5 Tri-Service General Hospital, National Defense Medical Center, Keelung branch, Taipei, Taiwan
  6. 6 Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
  1. Correspondence to Chun-Chi Lu, Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; chunchilu0{at}gmail.com

https://doi.org/10.1136/ard-2023-224899

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    A 73-year-old man with previous cerebral infarction, diabetes mellitus and IgG4-related disease had received rituximab treatment 2 years prior. He reported poor appetite for a week and was found to have grade I pitting oedema on both legs on physical examination. Contrast-enhanced CT revealed multiple low-density lesions in both kidneys (figure 1), dilatation of the common bile duct and intrahepatic ducts, diffuse enlargement of the pancreas and diffuse thickening of the retroperitoneum. Laboratory data showed elevated serum IgG4, hypocomplementemia, negative anti-phospholipase A2 receptor antibody, non-nephrotic range proteinuria without hematuria and markedly elevated creatinine. The renal biopsy demonstrated …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors M-KT drafted the manuscript. Y-LC performed the pathological analysis. C-CL critically reviewed the manuscript. H-CC, F-CL and D-MC conceptualised the study. All authors reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.