Lupus nephritis class I accompanied by tubulointerstitial nephritis with marked T-lymphocyte infiltration in an HTLV-1 positive patient

Abstract

We herein describe the case of a 40-year-old Japanese male who was admitted to our hospital because of a continuous remittent fever lasting 1 month. He fulfilled the items of the classification criteria for the diagnosis of systemic lupus erythematosus (SLE). The administration of 20 mg per day of oral prednisolone completely diminished his clinical symptoms. However, his renal biopsy performed 1 day after the admission showed marked pathognomonic characteristics. Not only did his glomeruli show class I lupus nephritis with mesangial depositions of IgG, IgA, C3, and C1q, but also tubulointerstitial nephritis with marked T-lymphocyte infiltration. These infiltrated T cells partly had nuclear atypia. The patient was positive for human T cell leukemia virus type 1 (HTLV-1) antibodies. Furthermore, clonal rearrangements of T cell receptorgamma chain gene was detected in the DNA extracted from his kidney sections by the polymerase chain reaction (PCR) method. A second renal biopsy 6 months after the prednisolone treatment showed that the infiltrating T lymphocytes had markedly diminished. This is the first case report of lupus nephritis class I with tubulointerstitial nephritis, which might include oncogenic T lymphocytes, in an HTLV-1 positive patient.