PMC5399207_01
The clinical course before admission. BCG: bacillus Calmette-Guerin, AKI: acute kidney injury, SCr: serum creatinine
1349-7235-56-0541-g001.jpg
PMC5399207_01_1349-7235-56-0541-g001.jpg
g001
Approximately 1 year prior to this presentation, he had been diagnosed with transitional carcinoma of the bladder and underwent endoscopic resection 8 months before admission, and bi-weekly administrations of Connaught strain BCG (80 mg) had been initiated 4 months before admission (Fig. 1).
(a), (b) purpuric lesions of both lower legs.
1349-7235-56-0541-g002.jpg
PMC5399207_01_1349-7235-56-0541-g002.jpg
g002
A physical examination revealed moderate pitting edema and palpable purpura on both lower legs (Fig. 2).
The renal biopsy findings. (a) Hematoxylin and Eosin staining (x25), showing a crescentic glomerulonephritis in 20% of glomeruli. (b) PAS stain (x400) and (c) silver stain (x400), showing a crescentic and fibrinoid necrotizing glomerulonephritis with focal rupture of the capillary walls. (d) Immunohistochemstry (x400), demonstrating granular staining for IgA deposits mainly in the mesangium. Scale bars: 200 microm (a) and 20 microm (b, c, d).
1349-7235-56-0541-g003.jpg
PMC5399207_01_1349-7235-56-0541-g003.jpg
g003
Renal biopsy showed a crescentic and fibrinoid necrotizing glomerulonephritis in 20% of glomeruli(Fig. 3a-c), and immunohistochemistry revealed IgA deposits mainly in the mesangium (Fig. 3d).