Abstract:
RATIONALE:Anti-glomerular basement membrane (GBM) disease is a T cell-mediated disease that has a poor prognosis with conventional therapy. We tested rituximab as a primary therapy to reduce anti-GBM antibody produced by B cells. PATIENT CONCERNS:A 53-year old woman with complaints of a fever, headache and abdominal discomfort showed renal failure with elevated anti-GBM antibody, and renal biopsy revealed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) 1 deposition along GBM. DIAGNOSES:The patient's plasma contained autoantibodies against Goodpasture antigen, which is the NC domain of collagen IVα3, and CD4-positive helper T cells were found surrounding crescent glomeruli with the coexistence CD20-positive B cells. INTERVENTIONS:Rituximab with steroid and plasma exchange. OUTCOMES:The levels of autoantibody for Goodpasture antigen were reduced, and the patient was able to temporarily withdraw from hemodialysis. LESSONS:B cell depletion with rituximab is effective as an initial therapy for anti-GBM disease.
journal_name
Medicine (Baltimore)journal_title
Medicineauthors
Uematsu-Uchida M,Ohira T,Tomita S,Satonaka H,Tojo A,Ishimitsu Tdoi
10.1097/MD.0000000000017801subject
Has Abstractpub_date
2019-11-01 00:00:00pages
e17801issue
44eissn
0025-7974issn
1536-5964pii
00005792-201911010-00120journal_volume
98pub_type
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