Steroid-resistant minimal change nephrotic syndrome associated with thymoma treated effectively with rituximab following thymectomy and cyclosporine: a case report

BMC Nephrol. 2024 Feb 9;25(1):53. doi: 10.1186/s12882-024-03485-2.

Abstract

Background: Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein describe a case of steroid-resistant MCNS associated with thymoma, treated effectively with rituximab.

Case presentation: A 71-year-old Japanese man was referred to our department with severe proteinuria (20 g/gCr). Renal biopsy showed minimal change disease and computed tomography revealed an anterior mediastinal mass. Based on these findings, he was diagnosed with thymoma-associated MCNS. He was treated with oral prednisolone (50 mg/day) and cyclosporine, and underwent thymectomy and plasma exchange. However, no improvement in proteinuria was observed. He therefore received intravenous rituximab 500 mg, resulting in a marked decrease in proteinuria from 5328 to 336 mg/day after 1 week.

Conclusions: This case suggests that rituximab might be an effective therapy in patients with steroid-resistant MCNS associated with thymoma.

Keywords: Minimal change nephrotic syndrome; Myasthenia gravis; Rituximab; Thymoma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cyclosporine / therapeutic use
  • Humans
  • Male
  • Nephrosis, Lipoid* / complications
  • Nephrosis, Lipoid* / drug therapy
  • Nephrotic Syndrome* / complications
  • Prednisolone
  • Proteinuria / etiology
  • Rituximab / therapeutic use
  • Thymectomy / adverse effects
  • Thymoma* / complications
  • Thymoma* / diagnostic imaging
  • Thymoma* / drug therapy
  • Thymus Neoplasms* / complications
  • Thymus Neoplasms* / surgery

Substances

  • Cyclosporine
  • Rituximab
  • Prednisolone