Immune Thrombocytopenic Purpura Complicated by Hepatitis C Virus-related Membranoproliferative Glomerulonephritis after Rituximab Therapy

Abstract

We herein report the case of a 54-year-old Japanese man with hepatitis C virus (HCV)-related membranoproliferative glomerulonephritis (MPGN), which developed at the time of relapse of immune thrombocytopenic purpura (ITP) after rituximab therapy. Antiviral therapy for HCV led to the improvement of both MPGN and ITP. Rituximab therapy may have contributed to the exacerbation of HCV infection and induced the development of HCV-related MPGN and the relapse of ITP. Our case suggested that HCV treatment should be prioritized over rituximab therapy for HCV-positive patients with ITP and that antiviral therapy for HCV may be effective for treating ITP itself.

Keywords: hepatitis C virus; immune thrombocytopenia; membranoproliferative glomerulonephritis; rituximab.

Figure 1.

Renal biopsy revealed enlargement of the glomeruli with mesangial proliferation, lobulation of the glomeruli (a, b), and double contours in the basement membranes (c, arrow). Microtubule-like deposits are diffusely observed in the subendothelial basement membrane and paramesagiual area on electron microscopy. (c, d) Immunofluorescence staining revealed IgM positivity in the basement membrane in the form of small granules (e), while IgG and C3 were negative (f, g). Exudative lesions in capillaries were observed in some glomeruli (h, arrow).

Figure 2.

The clinical course. HD-DEX: high dose dexamethasone, eGFR: estimated glomerular filtration rate, HCV: hepatitis C virus