A Case of Polymyositis Associated with Immunoglobulin A Nephropathy

Yoon-Jeong Oh; Eun Sung Park; Mi Jang; Ea Wha Kang; Jeong-Hae Kie; Sang-Won Lee; Jason Jungsik Song; Yong-Beom Park; Chan-Hee Lee; Jin-Su Park

doi:10.4078/jrd.2017.24.4.241

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Oh, Park, Jang, Kang, Kie, Lee, Song, Park, Lee, and Park: A Case of Polymyositis Associated with Immunoglobulin A Nephropathy

Case Report

J Rheum Dis 2017;24(4):241-245.

Published online: 31 October 2017

DOI: https://doi.org/10.4078/jrd.2017.24.4.241

A Case of Polymyositis Associated with Immunoglobulin A Nephropathy

Yoon-Jeong Oh¹, Eun Sung Park¹, Mi Jang², Ea Wha Kang³, Jeong-Hae Kie⁴, Sang-Won Lee¹, Jason Jungsik Song¹, Yong-Beom Park¹, Chan-Hee Lee⁵, Jin-Su Park⁵

¹Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

²Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

³Division of Nephrology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea

⁴Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

⁵Division of Rheumatology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Corresponding to: Jin-Su Park, Division of Rheumatology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100, Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea. E-mail: jinsulog@naver.com

Received 3 October 2016 Revised 2 January 2017 Accepted 16 March 2017

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Polymyositis (PM) is a chronic inflammatory disease that predominantly affects muscles. Systemic organ involvement, including the respiratory and gastrointestinal tracts, is frequently observed in PM, but renal involvement is rare. Herein, we report the case of a 56-year-old woman presenting with weight gain, edema, and generalized myalgia. Laboratory tests revealed elevated creatinine kinase level, hypoalbuminemia, and proteinuria. Histopathological examination of muscle biopsy revealed inflammatory myositis, and a renal biopsy confirmed immunoglobulin A (IgA) nephropathy. Based on the clinicopathological results, the patient was diagnosed with PM with IgA nephropathy. This is a report of a rare occurrence of IgA nephropathy in a patient with PM presenting with chronic glomerulonephritis.

Keywords: Polymyositis, IgA nephropathy, Proteinuria

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Figure 1.

Muscle biopsy. (A) Light microgram of a muscle biopsy specimen (H&E, ×40). (B) Light microgram showing inflammatory cell infiltrates (black arrows) scattered throughout the endomysium, invading individual muscle fibers (H&E, ×200).(C) On immunohistochemistry, the inflammatory cells express leukocyte common antigen (black arrows) (Immunohistochemistry,×200). (D) Anti CD 68 staining of the muscle biopsy specimen (Immunohistochemistry, ×200).

Figure 2.

Renal biopsy. (A) Light microgram showing mild mesangial expansion (black arrows) without cellular proliferation (Periodic acid Schiff, ×400). (B) Some glomeruli showed segmental sclerotic change and synechia with Bowman's capsule (PAS-silver stain, ×400). (C) Immunofluorescence staining revealed moderate positivity for IgA on the mesangium and para-mesangium (Immunofluorescence staining, ×400). (D) Electron microgram demonstrating deposits in the mesangium and para-mesangium (Uranyl acetate, ×6,000).

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