02-05-2015, 11:24 AM
A 59 y/o M present to you with rash and renal function. Palpable purpuric lesions were present on the buttocks, feet and sole. There is no clinical history of urticaria. A biopsy specimen of pat shown here.
http://i.imgur.com/thYfO8z.jpg?1 Direct immunofluorescent staining of the biopsy reveal granular deposits consisting primally of C3 and IgM in vascular patten in the papillary dermis. Evaluation of lab revealed anemia and renal insufficiency and (+) for microscopic proteinuria and hematuria in nephrotic range on urinary exam. Serum borderline ↓C3 & markedly ↓ for C4. And (-) for hep C,(-) for antistreptolysin O, (-) cryoglobulin (-) ANCA and ↑ RF. Renal biopsy reveal immune complex mediated diffuse proliferative glomerulonephritis and immunofluorescence studies also (+) mesangial and focal capillary loop dep C3, IgM and IgG. EM revealed small and subendothelial electro dense dep.
Dx?
a) Microscopic polyangiitis
b) Hypocomplementemic urticarial vasculitis
c) Cryoglobulinemic vasculitis
d) HSP
_________________like all my Qs 72sec_________________________post yr and 1st and tell me how you describe the slide?
http://i.imgur.com/thYfO8z.jpg?1 Direct immunofluorescent staining of the biopsy reveal granular deposits consisting primally of C3 and IgM in vascular patten in the papillary dermis. Evaluation of lab revealed anemia and renal insufficiency and (+) for microscopic proteinuria and hematuria in nephrotic range on urinary exam. Serum borderline ↓C3 & markedly ↓ for C4. And (-) for hep C,(-) for antistreptolysin O, (-) cryoglobulin (-) ANCA and ↑ RF. Renal biopsy reveal immune complex mediated diffuse proliferative glomerulonephritis and immunofluorescence studies also (+) mesangial and focal capillary loop dep C3, IgM and IgG. EM revealed small and subendothelial electro dense dep.
Dx?
a) Microscopic polyangiitis
b) Hypocomplementemic urticarial vasculitis
c) Cryoglobulinemic vasculitis
d) HSP
_________________like all my Qs 72sec_________________________post yr and 1st and tell me how you describe the slide?
