Case Report
On December 8, 2020, A 34-year-old Chinese woman was found to have renal
failure (creatinine of 778.4 umol/L) due to frequent vomiting. She had
not any medical history. Initial investigation showed renal failure,
moderate anemia, abnormal calcium and phosphorus metabolism, normal
complement and autoimmune antibodies test (supplementary table 1). A
kidney biopsy was performed to confirm the etiology of the renal
failure, which presented crescent glomerulonephritis, and multiple
immune complexes deposition in the mesangial, subcutaneous and
subepithelial areas with membranoproliferative and “full-house
nephropathy” pattern (figure 1, 2).
She was initiated on peritoneal dialysis (PD) due to renal failure.
After kidney biopsy, she received prednisone and intravenous
cyclophosphamide monthly. On January18th, 2021, she had a sudden,
unprovoked seizure with loss of consciousness that lasted about 6
minutes. She had no previous history of seizures.
Susceptibility-Weighted Imaging (SWI) showed hemosiderosis deposits in
cerebellar hemisphere and occipital lobe (figure 3). Immunoglobulin
(IVIG) , methylprednisolone, and hydroxychloroquine (HCQ) was chonsen to
treatment. But given that the subsequent serious pulmonary bacterial
infection, fungal enteritis and severe myelosuppression, she was no
longer treated with cyclophosphamide. After infection control, HCQ and
low-dose mycophenolate mofetil (MMF) was chosen as maintenance
treatment. The prednisolone taper was continued to a dose of 10mg/day.
The treatment is effective and the brain lesion was obviously shrinked
after 6 months (figure 3). She had no further seizures and no other
specific clinical symptoms within more than 3 years of clinical
follow-up .