PMC3482086_01
Tc-99m HMPAO (Ceretec) identical perfusion examinations performed with tarred doses of 30.0 mCi and acquisition beginning 15 min after injection with 20 min duration on a three-head gamma camera. The output pixels were co-registered with diffusion weighted MRI of the brain. Computer processing of the quantitative data shows a generalized increase in perfusion between the study prior to the initiation of immunosuppression and the study three weeks after initiation of immunosuppression.
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F1
However, a perfusion scintigraphy using Tc-99 HPCAC (SPECT) fused with an MRI showed symmetrically decreased brain perfusion more pronounced in the frontal lobes (fig. 1). Repeated fusion SPECT-MRI study of the brain one month after the first cyclophosphamide injection was normal (fig. 1).
Indirect immunofluorescence showing cytoplasmic staining with perinuclear accentuation on HEp-2 cells (a), anti-smooth muscle staining on mouse kidney/stomach (b), and c-ANCA on ethanol-fixed neutrophils (c).
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F2
Erythrocyte sedimentation rate was elevated; serologies revealed elevated CRP, low C3, positive rheumatoid factor, polyclonal hypergammaglobulinemia, and the presence of multiple autoantibodies including low-titer anti-nuclear/anti-cytoplasmic antibodies on Hep2 cells (fig. 2a), anti-phospholipid antibodies, anti-smooth muscle antibody (fig. 2b), antibodies to F-actin, c-ANCA (fig. 2c), PR3-ANCA, and, at a weak titer, MPO-ANCA.
Renal biopsy. a Glomerulus with a cellular crescent. Immunofluorence was negative and electron microscopy showed no deposits. b Interstitial nephritis. Eosinophils are noted among the cellular components of the interstitial infiltrate.
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F3
Percutaneous kidney biopsy showed crescentic glomerulonephritis and interstitial nephritis (fig. 3) with negative immunofluorescence and absence of glomerular deposits on electron microscopy.