PMC5546083_01
PMC5546083_02
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.
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fig1
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).
Full thickness fibrinoid necrosis of the vessels with surrounding interstitial necrosis.
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fig2
Fibrinogen staining showed crescents and necrosis of an artery (Figures 2-4).
Tubular atrophy with dense lymphocytic inflammatory infiltrate and interstitial fibrosis.
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fig3
Fibrinogen staining showed crescents and necrosis of an artery (Figures 2-4).
Fibrinogen staining shows cellular crescents (a) and necrosis of an artery (b).
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fig4
Fibrinogen staining showed crescents and necrosis of an artery (Figures 2-4).