Schistosoma mansoni and membranous nephropathy

Figure 2 | Ultrastructural findings showing glomerular capillaries with subepithelial and intramembranous electron-dense deposits besides intervening projections (spikes) regularly distributed on the glomerular basement membrane. Original magnification 8000. A 53-year-old Brazilian man presented with lower limb edema that progressed to anasarca. He had no personal or family history of renal disease. Laboratory tests revealed urea level, 35 mg/dl; hemoglobin value, 9.8 g/dl; leukocyte count, 7500/mm; platelet count, 204,000/mm; serum albumin level, 1.2 g/dl; total cholesterol level, 239 mg/dl; and low-density lipoprotein cholesterol level, 92 mg/dl. Urinalysis showed no leukocyturia or hematuria; the 24-hour urinary protein level was 19.7 g. Serum complement levels were normal. Autoantibody testing and serologic test results were negative for hepatitis B, hepatitis C, and HIV. Light microscopy in a renal biopsy sample revealed mesangial hypercellularity, diffuse chain-like thickening with some spikes of the basement membrane, and interstitial lymphocytes (Supplementary Figure S1 online). A foreign body giant cell reaction was seen around an elliptical structure with a lateral spicule, consistent with a Schistosoma mansoni egg (Figure 1). Immunofluorescence showed granular deposits of IgG, IgA, IgM, C1q, C3, kappa, and lambda in the glomerular capillary loop. The pathologic diagnosis was of stage III membranous nephropathy (Figure 2) with tubulointerstitial