PMC9198400_01
Light micrographs. Masson (A) and periodic acid-Schiff (PAS) (B) staining show crescent formation, fragmented capsule walls, and interstitial inflammatory infiltration. Periodic Schiff-methenamine silver (PASM) (C) staining reveals the formation of short subepithelial spikes (red arrow).
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F1
Formation of short subepithelial spikes, podocyte swelling, and vacuolar degeneration were also observed (Figures 1A-C).
IF results. Fine granular deposition of IgG along glomerular capillary walls and segmental while weak line-like change areas of some glomerular capillary wall and glomerular capsule wall due to IgG (A). Lumpy deposition of IgA in the mesangial area (B). Fine granular deposition of PLA2R along glomerular capillary walls (C).
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F2
Immunofluorescence (IF) demonstrated fine granular deposition of IgG (+++), PLA2R (+), THSD7A (-), IgG1 (++), IgG2 (-), IgG3 (-), IgG4 (+++), C1q (-), IgM (-), Fib (-), and C4 (-) along glomerular capillary walls; segmental while weak line-like change areas of some glomerular capillary wall and glomerular capsule wall due only to IgG; and lumpy deposition of IgA (+++) and C3 (++) in the mesangial area (Figures 2A-C).
Electron micrographs. Mild, irregular thickening of the GBM and electron-dense deposits in the subepithelial side of the GBM (A,B).
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F3
Electron-dense deposits were observed in the mesangial area (Figures 3A,B).
Clinical course. PSL: prednisolone, CTX: cyclophosphamide, PE: plasma exchange.
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F4
Regular clinical follow-up was conducted after discharge, and the orally administrated dose of prednisolone was gradually reduced (Figure 4).