PMC3808805_01
a Hematoxylin and eosin staining (HE), high power. Florid endocapillary hypercellularity with prominent monocytes and granulocytes within capillary loops with minimal mesangial matrix expansion and variable capillary wall thickening, morphologically consistent with cryoglobulinemic glomerulone-phritis. b HE, high power. Florid intimal arteritis involving the interlobular caliber artery. c HE, high power. Arteriole with inflammatory cell infiltration and eosinophilic material within the vessel wall consistent with cryoprecipitate. d HE, medium power. Monomorphic small lymphoid cells infiltrating the perinephric fat can be seen.
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F1
A renal biopsy was performed, which demonstrated a diffuse endocapillary proliferative glomerulonephritis (fig. 1).
Immunofluorescence demonstrated capillary wall positivity for kappa, IgM and C3 with negative IgG staining.
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F2
Capillary wall kappa, IgG, IgM and C3 were noted on immunofluorescence (fig. 2) and there were scattered subendothelial electron-dense immune-type deposits on electron microscopy.
a The lymphoid infiltrate showed strong diffuse CD20 staining. b CD3 staining highlighted only scattered reactive T lymphocytes.
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F3