Minimal change disease associated with malignant pleural mesothelioma: case report and review of the literature

Abstract

A 77-year-old man with a history of asbestos exposure was admitted to our internal medicine division for generalised weakness, fatigue, loss of weight, night sweats and difficulty for breathing since 3 months. Clinical examination revealed left fine crackles and bilateral leg oedema. Blood test showed elevated C reactive protein level at 142 mg/L, lactate dehydrogenase level at 421 UI, creatinine level at 5.75 mg/dL. Serum albumin level at 30 g/L, urinalysis showed significant proteinuria at 6.4 g/L. Chest X-ray showed left pleural effusion. Renal ultrasonography was normal. Thoracic CT and positron emission tomography showed mediastinal enlargement with lymphadenopathies and left pleural effusion and thickening. A pleural biopsy showed features compatible with malignant epithelioid mesothelioma. Renal biopsy showed minimal change disease and acute tubular necrosis. A diagnosis of malignant mesothelioma associated with minimal change disease and acute tubular necrosis secondary was then made. Given the poor general condition, palliative care was initiated and the patient died from respiratory failure 3 months later.

Secondary Minimal Change Disease Due to Pancreatic Cancer Improved by Chemotherapy

“…The remission rate is 80-90%, and immunosuppressive agents such as cyclophosphamide, cyclosporine, or tacrolimus are rarely necessary ( 12 ). However, when MCD is secondary to a paraneoplastic syndrome, the treatment of neoplasia should be considered ( 20 ). Kofman et al reported that 18 of 13,992 cases of non-Hodgkin lymphoma showed MCD, and that relapse of MCD occurred more frequently in patients treated only by steroids (77.8%) than those receiving combined therapy with steroids and other chemotherapeutic agents (25%) ( 13 ).…”

Enfermedad de cambios mínimos como glomerulopatía paraneoplásica en un paciente con tumor solido. Reporte de un caso

“…Debido a esto, existe un grupo de glomerulopatías paraneoplásicas descritas como clásicas, dada su relación altamente documentada con cierto tipo de neoplasias como la nefropatía membranosa asociada con tumores de pulmón, recto y próstata principalmente, y la enfermedad de cambios mínimos asociada al linfoma Hodgkin y algunos tipos de leucemias, habiendo escasos reportes sobre tumores sólidos, como el de recto, principal motivación para reportar este extraño caso [7,12,13].…”

“…Con este manejo se documentan tasas de remisión de hasta el 90 % al completar las 16 semanas [1,[15][16][17]. Sin embargo, en los casos secundarios relacionados con malignidad, el tratamiento debe ser el de la neoplasia perse, no encontrándose bene cio en el manejo con esteroides, e incluso, en algunos estudios, se documentó en este grupo de pacientes mayor riesgo de eventos adversos psiquiátricos y de recaída en los casos tratados únicamente con esteroides [4,10,12]. Esta fue la conducta establecida en nuestro paciente, quien recibió tratamiento con Capecitabina, primera línea de quimioterapia, además del manejo quirúrgico con resección del tumor a nivel local.…”

Nephrotic syndrome in a 60-year-old man

“…The total incidence of cancer among patients with MGN is 7.9% 2, reaching up to 22% in elderly patients 2. Since in most cases the nephrotic syndrome precedes about 6 months or appears parallel to the diagnosis of malignant pleural mesothelioma (MPM),3 it is important to perform an active search for occult neoplasia in adult patients with new-onset nephrotic syndrome, after ruling out a primary origin. The diagnosis of paraneoplastic nephrotic syndrome can be considered if the following criteria are present: (1) no evidence of other aetiology, (2) nephrotic syndrome appears 6 months before or after diagnosis of cancer, (3) cancer treatment is associated with a decrease of proteinuria and (4) tumour relapse is associated with an increase in proteinuria 1 3.…”

“…The association of MGN with pleural mesothelioma is very rare. In the review published by Yildiz H et al ,3 only 11 cases have been reported in the literature.…”