THE MAN WHO ‘CRIED’ WOLF: CRYOGLOBULINEMIC GLOMERULONEPHRITIS ASSOCIATED WITH T CELL LYMPHOMA

J LI1, M VUCAK-DZUMHUR1

1Westmead hospital, Sydney, NSW, Australia

Background: T cell lymphoma is uncommonly associated with renal disease. Published case reports have described lymphomatous infiltration, immune mediate glomerulonephritis and one case of cryoglobulinemia associated with angioimmunoblastic T cell lymphoma.

Case report: A 43-year-old Chinese man presented with transient neurological symptoms and features of nephritic syndrome with hypertension, microhaematuria and nephrotic range proteinuria (9g/day). Serology was suggestive of lupus nephritis with low complements, elevated double stranded DNA antibodies (dsDNA). The renal biopsy demonstrated membranoproliferative pattern glomerulonephritis but immunofluorescence was inconsistent with lupus, given it showed positive IgM, C3 with weak IgG, C1q and negative C4d staining. Electron microscopy revealed electron dense deposits with heterogeneous ultrastructures consistent with cryoglobulin deposits.

Further evaluation with a lymph node biopsy revealed EBV negative, nodal T cell lymphoma, which was subsequently demonstrated on the original renal biopsy. A positron emission tomography confirmed lymphomatous infiltration of the kidneys. There has been an encouraging response to chemotherapy, with marked reduction in proteinuria and normalisation of complement and dsDNA levels.

Conclusions: We present a unique case of renal T cell lymphoma associated with cryoglobulinemic glomerulonephritis, which was characterised by heavy proteinuria, membranoproliferative pattern glomerulonephritis from cryoglobulin deposition. The association between T cell lymphoma, auto antibodies and cryoglobulinemia may represent a paraneoplastic phenomenon. His renal prognosis has been excellent.

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