PMC5164895_01
The initial MRI (images (a)-(c)) showed typical holohemispheric involvement: axial view in FLAIR (see (a), (b)) and T2-weighted (see (c)) images with extensive areas of high signal intensity in the subcortical white matter of both parietooccipital regions, including frontal lobes. Second MRI (images (d)-(f)) performed 2 weeks later with no signal abnormality within the brain parenchyma on FLAIR (see (d), (e)) and T2-weighted (see (f)) images.
CRIN2016-7104098.001.jpg
PMC5164895_01_CRIN2016-7104098.001.jpg
fig1
First brain MRI showed extensive areas of high signal intensity in the subcortical white matter of both parietooccipital regions, as well as in the frontal lobes and right basal ganglia/capsular region and the head of the caudate nucleus on the left (Figures 1(a)-1(c)) on both FLAIR and T2-weighted images.
Renal biopsy with crescent formations (image (a)). Immunofluorescent findings (image (b)) of diffuse granular mesangial and glomerular capillary wall staining for IgG, IgM, IgA, C3, and C1; tubular basement membrane and arteriolar staining for IgG, IgM, and C3; vessel wall staining for IgG, IgM, and C3. Arterioles with focal luminal obliteration and concentric intimal fibroplasia (image (c)). Moderate fibrosis (image (d)). Findings consistent with lupus nephritis and severe hypertension.
CRIN2016-7104098.002.jpg
PMC5164895_01_CRIN2016-7104098.002.jpg
fig2
The kidney biopsy showed diffuse endocapillary and extracapillary proliferative and membranous lupus nephritis (ISN-RPS class IV-G+V), new changes with endothelial swelling secondary to severe hypertension, but no evidence of thrombotic microangiopathy (Figure 2).