Li XL, Ma ZG, Huang WH, Chai EQ, Hao YF. Successful treatment of pyoderma gangrenosum with concomitant immunoglobulin A nephropathy: A case report and review of literature. World J Clin Cases 2018; 6(13): 703-706 [PMID: 30430129 DOI: 10.12998/wjcc.v6.i13.703]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Li Li, Zhi-Gang Ma, Wen-Hui Huang, Department of Nephrology, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Er-Qing Chai, Yun-Fei Hao, Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Author contributions: Hao YF and Ma ZG designed the study. Li XL and Huang WH collected the patient’s clinical data. Chai EQ analyzed the data and wrote the paper.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing the use and disclosure of her protected health information.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun-Fei Hao, MD, Attending Doctor, Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou 730000, Gansu Province, China. hyf897@sina.com
Telephone: +86-18893114576
Received: July 30, 2018 Peer-review started: July 30, 2018 First decision: August 31, 2018 Revised: September 20, 2018 Accepted: October 11, 2018 Article in press: October 12, 2018 Published online: November 6, 2018 Processing time: 99 Days and 20.7 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A 20-year-old female with pyoderma gangrenosum (PG) with concomitant immunoglobulin A (IgA) nephropathy was successfully treated.
Clinical diagnosis
According to the laboratory results and clinical manifestations, nephric syndrome and PG were diagnosed.
Differential diagnosis
Skin infections should be excluded.
Laboratory diagnosis
High proteinuria (13 g/24 h), hypoalbuminemia (16 g/L) and hyperlipidemia suggested nephrotic syndrome.
Imaging diagnosis
Abdominal ultrasound indicated normally sized kidneys and massive ascites.
Pathological diagnosis
Renal biopsy showed IgA nephrology, with stronger staining (3+) for IgA and C3 in the mesangial area, and skin biopsy indicated massive small lymphocytes arranged around blood vessels throughout the dermis, suggesting vasculitis.
Treatment
Prednisolone at 1 mg/kg plus cyclophosphamide at 0.6 mg/2wk, followed by prednisone at 5 mg/kg plus cyclosporine A (CsA) at 3 mg/(kg∙d) (75 mg b.i.d.).
Related reports
There are no reports of coexistence of PG and IgA nephropathy. This is the first reported case of PG with concomitant IgA nephropathy to be successfully treated.
Term explanation
PG and IgA nephropathy are both autoimmune diseases.
Experiences and lessons
Low-dosage prednisone (5 mg/kg) plus CsA may be helpful in patients with PG concomitant with IgA nephropathy.
