PMC9972904_01
PMC9972904_02
First skin biopsy: (A) orthokeratosis and parakeratosis, (B) parakeratosis (arrow), and (C) rare fungal spores (PAS-D stain). PAS-D: Periodic acid-Schiff with diastase.
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FIG1
Skin biopsy (Figure 1) from the left thigh was consistent with tinea corpora; therefore, she was administered betamethasone and ketoconazole.
Second skin biopsy showed (A) increased dermal mucin (as indicated by the arrow tip) and (B) a thick basement membrane shown at higher magnification (indicated by the arrow)
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FIG2
Skin biopsy repeated after six months (Figure 2) revealed a prominent basement membrane with dermal mucin, suggesting an underlying autoimmune disease.
Light microscopic findings from a kidney biopsy: (A) a glomerulus with mesangial proliferation, endocapillary hypercellularity (short arrow), and segmental narrow double contour (long arrow), PAS stain; (B) a glomerulus with prominent subendothelial immune deposits in the form of wire-loop lesion (one short arrow) and hyaline thrombi (two long arrows), H&E stain. PAS: Periodic acid-Schiff; H&E: Hematoxylin and eosin.
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FIG3
Renal biopsy revealed diffuse membranoproliferative glomerulonephritis on light microscopy (Figure 3).
Kidney biopsy, direct immunofluorescence staining, granular mesangial and capillary wall staining. (A) IgG of 1+ intensity. (B) IgM of 1+ intensity. (C) IgA of 1+ intensity. (D) C1q of 2+ intensity. C3, kappa, and lambda light chain stains were of the same distribution and intensity of IgG (not shown).
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FIG4
Direct immunofluorescence staining demonstrated considerable mesangial and capillary wall staining for IgG, IgA, and IgM as well as kappa and lambda light chains (full house pattern) in the glomerular mesangium and capillary walls (Figure 4).