Case Report: Acute Cerebellar Thrombosis in an Adult Patient with IgM Nephropathy

Abstract

IgM nephropathy is a relatively rare cause of idiopathic nephrotic syndrome.1 It was initially described by van de Putte,2 then by Cohen and Bhasin in 1978, as a distinctive feature of mesangial proliferative glomerulonephritis.2 It is typically characterized by diffuse IgM deposits on the glomeruli and diffuse mesangial hypercellularity. Little is known about the pathogenesis and treatment of this disease.1,3 We describe a patient who presented with nonspecific symptoms of epigastric pain, nausea, and early satiety. Abdominal imaging and endoscopies were unremarkable. She was found to have significant proteinuria (6.4 g/24 hours), hyperlipidemia, and edema consistent with a diagnosis of nephrotic syndrome. Kidney biopsy was performed and confirmed an IgM nephropathy. Less than 2 weeks after her diagnosis of IgM nephropathy, she presented with an acute cerebellar stroke. Thrombophilia is a well-known complication of nephrotic syndrome, but a review of the literature failed to show an association between IgM nephropathy and acute central nervous system thrombosis.

Keywords: IgM nephropathy; cerebellar thrombosis; thromboembolic events.

A. Adike, M.D.

Figure 1.

Glomerulus with mild segmental mesangial sclerosis (PAS stain, x 400).

Figure 2.

Glomerulus with mesangial deposition of immunoglobulin M (immunofluorescent staining, x 400).

Figure 3.

Electron microscopic study showing normal glomerular basement membrane, mild mesangial sclerosis, and segmental effacement of foot processes (electron microscopy, x 8000).