Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2018; 6(13): 703-706
Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.703
Successful treatment of pyoderma gangrenosum with concomitant immunoglobulin A nephropathy: A case report and review of literature
Xiao-Li Li, Zhi-Gang Ma, Wen-Hui Huang, Er-Qing Chai, Yun-Fei Hao
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.