Tubulointerstitial nephritis with IgG4-positive plasma cell infiltration and tertiary lymphoid tissue in a patient with cryoglobulinemic vasculitis: a case report

Yoshikuni Nagayama; Sakurako Yoshioka; Ayana Ichikura-Iida; Takashi Inoue; Koki Maeda; Masako Otani; Shigeki Iwasaki

doi:10.1007/s13730-024-00884-0

Tubulointerstitial nephritis with IgG4-positive plasma cell infiltration and tertiary lymphoid tissue in a patient with cryoglobulinemic vasculitis: a case report

CEN Case Rep. 2024 May 15. doi: 10.1007/s13730-024-00884-0. Online ahead of print.

Authors

Yoshikuni Nagayama¹, Sakurako Yoshioka², Ayana Ichikura-Iida², Takashi Inoue², Koki Maeda³, Masako Otani⁴, Shigeki Iwasaki²

Affiliations

¹ Department of Nephrology, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawa Nisimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan. ynaga1147@yahoo.co.jp.
² Department of Nephrology, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawa Nisimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan.
³ Department of Diagnostic Pathology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
⁴ Department of Pathology, International University of Health and Welfare Mita Hospital, Tokyo, Japan.

PMID: 38750297
DOI: 10.1007/s13730-024-00884-0

Abstract

Tertiary lymphoid tissue (TLT) develops at sites of chronic immune stimulation, including infection, autoimmune disease, transplant rejection, and cancer. Recently, TLT has been focused on an indicator for poor renal prognosis in various kidney diseases. In cryoglobulinemic vasculitis (CV), specific glomerular and vascular lesions are seen; however, tubulointerstitial lesions are usually nonspecific. We herein report the case of a 74-year-old man with idiopathic CV with rare tubulointerstitial lesions, such as tubulointerstitial nephritis (TIN) with IgG4-positive plasma cell infiltration and TLT. To our knowledge, this is the first report identifying TLT in the kidney biopsy in a patient with CV. Glucocorticoid improved the renal outcome. The association between CV and TIN with TLT remains unknown.

Keywords: Cryoglobulinemic vasculitis; Immunoglobulin G4; Immunoglobulin G4-related kidney disease; Immunoglobulin G4-related tubulointerstitial nephritis; Tertiary lymphoid tissue.