Tubulointerstitial nephritis in a patient with probable autoimmune lymphoproliferative syndrome

J Pediatr Hematol Oncol. 2013 Jul;35(5):e187-9. doi: 10.1097/MPH.0b013e31828ac9fe.

Abstract

Autoimmune lymphoproliferative syndrome (ALPS) is caused by a nonmalignant defective Fas-mediated apoptosis. The main clinical manifestations are chronic lymphadenopathy, splenomegaly, and autoimmune cytopenia. Most patients with ALPS have a FAS germline mutation. ALPS has occasionally been associated with glomerulonephritis and we present the first report of tubulointerstitial nephritis associated with probable ALPS. A 5-year-old girl presented with fever, vomiting, hypertension, and azotemia. No autoantibodies, viral, or streptococcal antibodies were detected. A renal biopsy showed small-vessel vasculitis with normal glomeruli and inflammation in the interstitium. The patient responded to prednisolone treatment and obtained a full renal recovery. Symptoms of connective tissue disorder supervened and after the development of more pronounced splenomegaly, a diagnosis of ALPS was confirmed.

Publication types

  • Case Reports

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • Autoimmune Lymphoproliferative Syndrome / complications*
  • Autoimmune Lymphoproliferative Syndrome / pathology
  • Child, Preschool
  • Female
  • Humans
  • Nephritis, Interstitial / drug therapy
  • Nephritis, Interstitial / etiology*
  • Nephritis, Interstitial / pathology
  • Prednisone / therapeutic use

Substances

  • Anti-Inflammatory Agents
  • Prednisone