J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Case Report

Volume 10, Number 10, October 2018, pages 786-790

Methimazole-Induced Pauci-Immune Glomerulonephritis and Anti-Phospholipid Syndrome: An Important Association to Be Aware of

Figure 1. Representative photomicrographs of glomerular changes consistent with pauci-immune focal necrotizing and crescentic glomerulonephritis. (a) Cellular crescent. (b) Segmental fibrinoid necrosis. (c) Patchy scarring with inflammation. (d) Normal glomerulus (H&E, ×400).

**Table 1.** Summary of Laboratory Results
Laboratory data	Before steroids	After steroids*	10 days after discharge	45 days after discharge
Data not available. Complete metabolic profile (day 14 after starting steroids); urinalysis (day 4 after starting steroids); *24-h urine protein (day 2 after starting steroids). ANA: antinuclear antibody by enzyme immune assay; ANCA: antineutrophil cytoplasmic antibody; MPO IgG: myeloperoxidase antibody; complement levels: C3, C4; ESR: erythrocyte sedimentation rate; LDL: low-density lipoprotein; anti-ds DNA: anti-double-stranded DNA antibody); RBC: red blood cells; WBC: white blood cells; MCV: mean corpuscular volume; eGFR: glomerular filtration rate.
Serum chemistry profile
Na (mmol/L)	132	134	137	139
K (mmol/L)	4.0	4.4	5.0	4.3
Cl (mmol/L)	98	99	100	97
HCO₃ (mmol/L)	25	26	31	29
BUN (mg/dL)	17	31	32	20
Creatinine (Cr) (mg/dL)	1.06	0.91	0.85	0.81
eGFR	> 60	> 60	102	90
Complete blood count
Hemoglobin (12.0 - 17.5 gm/dL)	8.5	8.9	11.9
MCV (80 - 100 fL)	86.1	87.6	90.3
Hematocrit (36-53%)	26.0	28.2	36.7
WBC (4.5 - 11.0 k/µL)	9.4	13.8	9.3
Neutrophil (50-70%)	80.4	77.8	92.3
Lymphocyte (25-43 %)	12.2	14.8	6.1
Platelet (140 - 450 k/µL)	223	277	197
Urinalysis
Specific gravity	1.022	1.013		1.015
pH (4 - 8)	6.0	7.0		7.0
WBC	3 - 5	0 - 2		0 - 4
RBC	15 - 20	8 - 10		None
Blood	Large	Small		None
Protein (mg/dl)	100	Negative		Negative
Cast	0 - 2, hyaline	None		0 - 4, hyaline
Urine protein/Cr (mg/g)	2,124.35
24-h urine protein		1,168*
Urine protein (random) (4 - 14 mg/dL)		73		8
ANA (< 0.90)	1.91		Negative
ANCA (< 1:20)	< 1:20
MPO IgG (0 - 19 unit/mL)	50		< 1	7.21
Serine protease-3 (0 - 19 unit/mL)	32		< 1	4.98
C3 (85 - 170 mg/dL)	102		120
C4 (16 - 40 mg/dL)	19.8		25
Anti-ds DNA IgG	Negative
Cardiolipin IgM (< 20)	13
Cardiolipin IgG (< 20)	124
C reactive protein (0 - 0.744mg/dL)	15.28	2.58
ESR (0 - 20 mm/h)	119	60
LDL (< 130 mg/dL)	105
Quantiferon gold	Negative

Table 1. Summary of Laboratory Results

Laboratory data

Before steroids

After steroids*

10 days after discharge

45 days after discharge

Data not available. *Complete metabolic profile (day 14 after starting steroids); *urinalysis (day 4 after starting steroids); *24-h urine protein (day 2 after starting steroids). ANA: antinuclear antibody by enzyme immune assay; ANCA: antineutrophil cytoplasmic antibody; MPO IgG: myeloperoxidase antibody; complement levels: C3, C4; ESR: erythrocyte sedimentation rate; LDL: low-density lipoprotein; anti-ds DNA: anti-double-stranded DNA antibody); RBC: red blood cells; WBC: white blood cells; MCV: mean corpuscular volume; eGFR: glomerular filtration rate.

Serum chemistry profile

Na (mmol/L)

132

134

137

139

K (mmol/L)

4.0

4.4

5.0

4.3

Cl (mmol/L)

100

HCO₃ (mmol/L)

BUN (mg/dL)

Creatinine (Cr) (mg/dL)

1.06

0.91

0.85

0.81

eGFR

> 60

102

Complete blood count

Hemoglobin (12.0 - 17.5 gm/dL)

8.5

8.9

11.9

MCV (80 - 100 fL)

86.1

87.6

90.3

Hematocrit (36-53%)

26.0

28.2

36.7

WBC (4.5 - 11.0 k/µL)

9.4

13.8

9.3

Neutrophil (50-70%)

80.4

77.8

92.3

Lymphocyte (25-43 %)

12.2

14.8

6.1

Platelet (140 - 450 k/µL)

223

277

197

Urinalysis

Specific gravity

1.022

1.013

1.015

pH (4 - 8)

6.0

7.0

WBC

3 - 5

0 - 2

0 - 4

RBC

15 - 20

8 - 10

None

Blood

Large

Small

None

Protein (mg/dl)

100

Negative

Cast

0 - 2, hyaline

None

0 - 4, hyaline

Urine protein/Cr (mg/g)

2,124.35

24-h urine protein

1,168*

Urine protein (random) (4 - 14 mg/dL)

ANA (< 0.90)

1.91

Negative

ANCA (< 1:20)

< 1:20

MPO IgG (0 - 19 unit/mL)

< 1

7.21

Serine protease-3 (0 - 19 unit/mL)

< 1

4.98

C3 (85 - 170 mg/dL)

102

120

C4 (16 - 40 mg/dL)

19.8

Anti-ds DNA IgG

Negative

Cardiolipin IgM (< 20)

Cardiolipin IgG (< 20)

124

C reactive protein (0 - 0.744mg/dL)

15.28

2.58

ESR (0 - 20 mm/h)

119

LDL (< 130 mg/dL)

105

Quantiferon gold

Negative