2013 Volume 123 Issue 7 Pages 1229-1235
A 61-year-old man had been diagnosed with immunotactoid glomerulopathy 5 years previously and had been on hemodialysis. He had also suffered from multiple embolisms in several organs and had continued anticoagulant therapy. He developed purpura on the left heel and right external malleolus three months before his first visit to us. The purpuric lesions had expanded and ulcerated; moreover, the left foot had developed gangrene. Histological examination of the skin around the ulcer showed homogeneous eosinophilic material in the vascular lumen, and the material was positive for the immunohistchemical stain for IgA. He also suffered a cerebral infarction as the foot gangrene progressed. The results of a skin biopsy indicated that deposition of immune reactants had induced these embolisms in the vessels of the foot and brain in a way similar to that of the glomerular lesions, so we chose immunosuppressive therapy instead of additional anticoagulant therapy. After this immunosuppressive therapy, his paralytic symptoms caused by the cerebral infarction improved and the expansion of his gangrene halted. In most cases of immunotactoid glomerulopathy, the deposition of immune reactant is almost exclusively restricted to the glomeruli. This is a rare case of immunotactoid glomerulopathy affecting multiple organs and developing foot gangrene.
