Authors: Kuppachi S, Chander P, Yoo J
A 43-year-old black male was brought to hospital with complaints of confusion and fever. He was noted to have petechial lesions, thrombocytopenia (platelet count 7,200/ml), schistocytes on peripheral smear, and serum creatinine 1.7 mg/dl (150.28 µmol/L). He was diagnosed to have thrombotic thrombocytopenic purpura (TTP) and started on high dose IV steroids and plasmapheresis. Attempts at steroid withdrawal following plasmapheresis were unsuccessful as his platelet count started to decrease. He subsequently was started on rituximab given as 4 weekly infusions. The platelet count normalized after 2 doses of rituximab. A kidney biopsy performed to evaluate proteinuria (10.24 gms/24 hr) revealed membranous nephropathy (MN), with organized obl...