Pulmonary manifestations of systemic karyomegaly

Abstract

Over 40 years ago, abnormal enlargement of the nucleus of tubular epithelial cells was reported in a rare distinct hereditary chronic interstitial nephritis, karyomegalic interstitial nephritis (KIN). Here, we report the second case of systemic karyomegaly with pulmonary manifestations and present a detailed characterization of the karyomegalic cells in lung parenchyma. A 59-year-old woman who was diagnosed with KIN developed renal failure and eventually received a renal transplant later evaluated for chronic and progressive restrictive lung disease. The KIN diagnosis prompted us to carefully examine her lung parenchyma. Karyomegalic cells were identified in the alveolar epithelium, interstitium, as well as, in the vascular wall. Viral serological and biochemical blood analyses were negative. We consider that the pulmonary manifestations of karyomegaly expands the differential diagnosis of interstitial lung disease in patients with KIN.

Keywords: Interstitial lung disease; Karyomegalic interstitial nephritis; Karyomegaly.

Fig. 1

Histopathological image of renal cortex demonstrates enlarged and hyperchromatic karyomegalic tubular epithelial cells (white arrows). Original magnification x200. Hematoxylin & Eosin stain.

Fig. 2

Pulmonary radiological changes as detected by CT-thorax analysis (A). Progression of these changes 6 months (B) and 18 months later (C).

Fig. 3

Images of the lung that show a histological pattern of usual interstitial pneumonia, with subpleural fibrosis and scattered fibroblastic foci (black arrows) (A). Pulmonary parenchyma demonstrates karyomegalic cells (white arrows) within the alveolar epithelium (B), alveolar (C) and perivascular (D) interstitium. (A) Original magnification x40, (B–D) x200. Hematoxylin & Eosin stain.