Acta Morphologica 24. (1976)

1-2. szám - Pathologia - Nagy Judit–Pár A.–Bajtai G.–Ambrus Mária–Deák G.: Membraneous Glomerulonephritis Induced by HB8 (Australia) Antigen-Antibody Complexes

130 JUDIT NAGY et al. Report of a case In November, 1973 a 68 year old male patient was admitted for sus­pected abdominal tumour. For a year and a half he had had anorexia, fatigue and weight loss. Clinical examination failed to verify a tumour. Vascular decompensation with cirrhosis of the liver with ascites and generalized oede­mas was diagnosed. Blood pressure was 145/100 mm Hg. Selected laboratory data. ESR. 75 mm/hrs; serum bilirubin, 1.7 mg per 100 ml (direct, 1.1 mg per 100 ml); thymol turbidity, 33 IU; SCOT, 60 IU; SGTP, 24 IU; ALP, 79 IU; prothrombin tissue, 59%; antinuclear factor, positive; LE cell test, negative; Waaler—Rose test, 1 : 128; latex test, Serum immunoglobulins: IgG, 985 mg per 100 ml; IgM 79 mg per 100 ml; IgA, 800 mg per 100 ml. Serum total complement level (according to Mayer), 5 IU (low) C3 : 52 mg per 100 ml. By immunoelectro-osmophoresis, HBS antigen in serum was negative at the onset, then repeatedly positive, HBS antibody in serum was repeatedly negative. Bleeding time was 7 minutes; coagulation time, 12 min; prothrom­bin activity, 59%; thrombin time was prolonged. Thromboelastography (TEG): prolonged к-time, decreased maximum elasticity. Pathologic thrombo­­cytic functions, paradoxical heparin effect were observed. The coagulation status refers to chronic aggressive hepatitis. Complement fixation reaction with aldogenic-liver cell nuclear and microsomal fraction was positive. Serum cholesterol, 358 mg per 100 ml; serum total lipids, 978 mg per 100 ml; serum total protein 6.6 g per 100 ml; albumin, 2.7 g per 100 ml; gamma globulins, 2.2 g per 100 ml. Rest nitrogen NPN level, at admission 34, later 59 mg per 100 ml. Decreased renal functions: creatinine clearance, 42 ml per min, serum creatinine, 1.5 mg per 100 ml. In view of the haemophilia, no liver and renal biopsy could be performed. After rapid progression, the patient died with uraemic symptoms. Necropsy data (Dr. I. Mészáros). Ascites 3500 ml. Weight of liver: 1250 g. The surface is composed of nodules of lentil or bean size. It is hard, light grey. The nodular structure is obvious even on the cut surface. The kidneys weigh 240 g, their capsule was easily removed. Their surface is finely granular, on the cut surface a slightly narrowed, light cortical substance and a somewhat hyperaemic medullary substance arc visible. The renal pelvis and ureters are free. On the surface of the pancreas and in its surround­ings there are several whitish, friable nodules of pin head size. The cut surface shows moderate vascularization and a glandular structure with several white nodules. In the inferior part of the oesophagus there are dilated, twisting veins. The stomach contains about 500 ml dark-brown substance, the gastric mucosa is anaemic. In the region below the pylorus, an ulcer 1.5 cm in diameter is Acta Morphologica Academiae Scientiarum Hungaricae 24, 1976

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