PMC10479603_01
Splinter hemorrhages on bilateral hands.
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Her physical examination was significant for tachycardia, vesicular lip lesions, minimal wheezing in the right upper lung field, and splinter hemorrhages and purpura of the fingers ( Figure 1 ).
(A) Renal biopsy tissue with hematoxylin and eosin staining showing crescentic and necrotizing glomeruli. (B) Renal biopsy tissue with Jones silver staining showing a glomerulus with segmental necrosis and glomerular basement membrane disruption.
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Examination of approximately 50 glomeruli in paraffin sections revealed 25 (50%) with segmental necrosis/endocapillary hypercellularity and 18 (36%) with necrosis with full crescents ( Figure 2 ).
Cardiac positron emission tomography/computed tomography images obtained (A) during initial hospitalization, showing FDG activity surrounding the myocardium, and (B) 4 months after hospitalization, showing improvement of FDG activity surrounding the myocardium.
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She was treated with one dose (1 g) of rituximab, followed by a second dose 2 weeks after the first dose ( Figure 3 ).
(A) Proteinase 3 antibody after treatment with pulse steroids, plasmapheresis, and rituximab. (B) Creatinine trend after treatment with pulse steroids, plasmapheresis, and rituximab.
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The patient's renal disease subsequently went into almost complete remission; most recently, in December 2022, her creatinine was 0.98 mg/dL with bland urine negative for ANCA ( Figure 4 ).