Diagnose This! (November 27, 2017)

What is your diagnosis (IgG stain shown)?

  ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​

  ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​

The image show an IgG immunofluorescent stain with intense capillary wall and mesangial staining. While much of the capillary wall staining cannot be localized, some areas show a subendothelial pattern of deposition. Additionally, a tissue ANA pattern can be seen in the background. The presence of diffuse capillary wall and mesangial IgG staining with a tissue ANA pattern is highly suggestive of lupus nephritis which is the correct diagnosis in this case. Additionally, the presence of significant subendothelial located deposits is consistent with a proliferative lupus nephritis (ISN/RPS classes III and IV) which was correct in this case (diffuse lupus nephritis, ISN/RPS Class IV).