A 43-year-old woman was admitted to our hospital for myalgic pain and erythema of the face and thighs. She had been diagnosed with dermatomyositis at another hospital 8 years earlier and proteinuria had developed suddenly. Renal histological examination revealed membranous nephropathy. Membranous nephropathy associated with dermatomyositis is very rare. To date, malignant disease has not been detected in our patient, but the serum level of CA125, a tumor marker, has been elevated to 1,097 U/ml. The increased CA125 level is related to the degree of proteinuria and after prednisolone and cyclosporine therapy, proteinuria and the CA125 level gradually decreased.
Gastric ulceration is a rare manifestation of cytomegalovirus (CMV) infection in the immunocompromised host. Two cases with CMV‐associated gastric ulcers in immunocompromised patients are reported. Case 1 involved a 65‐year‐old male who underwent a cadaveric renal transplantation because of chronic renal failure. He was treated with immunosuppressive agents and steroids. After 3 months of the treatment, he developed CMV‐associated gastric ulcers with evidence of CMV inclusion bodies, CMV antigen and CMV–DNA in the gastric ulcers. After three courses of ganciclovir therapy for 5 months, endoscopic images revealed complete healing of the gastric ulcers. This case supports the use of ganciclovir, which can lead to complete healing of gastric ulcers caused by CMV. Case 2 involved a 69‐year‐old male with interstitial pneumonia who was admitted to hospital because of rapid progression of interstitial pneumonia. He was treated with repeated pulses of methylprednisolone and cyclophosphamide. He developed CMV‐associated gastric ulcers with evidence of CMV inclusion bodies, CMV antigen and CMV–DNA in the gastric ulcers after 1 month of the treatment with high doses of methylprednisolone and cyclophosphamide. Endoscopic images revealed multiple ulcers and erosions in the gastric antrum. Ganciclovir treatment was started, but he died of interstitial pneumonia. In this case, the ulcers were considered to be precipitated by CMV infection and the use of a high dose methylprednisolone. These cases emphasize the need for a careful histological examination for CMV in gastric ulcers in immunocompromised patients.
A 72-year-old female was admitted to our hospital for massive proteinuria. She had previously been diagnosed with hepatitis C virus (HCV) infection and macroglobulinemia. Renal histological examination demonstrated membranoproliferative glomerulonephritis (MPGN), and type 2 cryoglobulinemia was positive in her serum. It is generally recognized that MPGN is the most common nephritis associated with HCV infection and cryoglobulinemia, but this is the first report of an HCV-infected patient with macroglobulinemia associated with MPGN. After treatment with prednisolone and melphalan, proteinuria disappeared, but macroglobulinemia and cryoglobulinemia were not improved.
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