Skin biopsy showed epidermal hyperplasia with diffuse lymphocytes and scattered eosinophils around the blood vessels in the dermis (Fig. estimated 2% prevalence among the healthy population.[2] The most common variant of psoriasis TSPAN11 associated with IgAN is psoriatic vulgaris, and several cases have been reported.[3C6] As IgAN may be one of its systemic inflammatory manifestations, psoriatic nephropathy was proposed to demonstrate their close connection.[7,8] Erythrodermic psoriasis (EP) is a relatively rare and severe variant of psoriasis, which accounts for approximately 1% to 2% of all psoriatic patients.[2] Cases of IgAN associated with EP are rare, and the pathogenesis is poorly understood. We report an old Chinese man who had IgAN and EP at the same time, and an investigation of a possible pathophysiological link and evidence toward the possible pathogenesis. Written informed consent was provided by the patient for publication of this case report and accompanying images, and this study was approved by the ethics committee of the First Hospital of Jilin University (ethics approval No. 20180201-IRB-00356). 2.?Case presentation A 74-year-old Chinese man visited the department of dermatology with a major complaint of deteriorating symptoms (erythroderma, skin pruritus, and pain) of psoriasis. He was diagnosed as having psoriasis vulgaris 20 years before and did not receive appropriate medical care during this period. His medical and surgical histories were unremarkable except for psoriasis vulgaris. He reported having a tobacco smoke addiction with an average JNJ-10397049 of 10 cigarettes per day and occasional alcohol consumption. The patient’s temperature was 37.5C; blood pressure, 148/98 mm Hg; heart rate, 114?beats/min; respiratory rate, 20?breaths/min; and pulse oximetry saturation, 98%. Physical examination indicated erythrodermic skin on approximately 90% of the whole body, including the face, chest, back, abdomen, and extremity. Moreover, some lesions were severe with escharosis. A routine blood test revealed white blood cells of 14.11??109/L (reference range, 4.0??109 to 10??109?cells/L) with 13% eosinophils (reference range, 0.4C8%). As the pitting edema on his legs was remarkable, routine urine test was recommended and revealed urine occult blood (2+), protein (3+), and ketobodies (3+). The urinary parameter values were as follows: protein, 5.58?g (reference: 0.2?g); microalbumin, 4212?mg (reference: 0C60?mg); -microglobulin, 64.74?mg (reference, 24?mg); and 2-microglobulin, 1.5?mg (reference: 0.4?mg) in 24-h urine. The C-reactive protein level was 57.2?mg/L (reference: 0C3.5?mg/L); and lactate dehydrogenase level, 441?U/L (reference: 135C226?U/L). Regarding liver function, the total protein content was 57.6?g/L (reference: 65C85?g/L) and albumin content was 24.2?g/L (reference: 40C55?g/L). Skin biopsy showed epidermal hyperplasia with diffuse lymphocytes JNJ-10397049 and scattered eosinophils around the blood vessels in the dermis (Fig. ?(Fig.1).1). Accordingly, the patient was diagnosed as having EP. The severe immunological derangement suggested by EP may also mediate renal dysfunction. Thus, we performed a kidney biopsy, which disclosed diffuse moderate hyperplasia in glomerular endothelial and mesangial cells, and mesangial matrix JNJ-10397049 with IgA deposition. We also detected a thickened glomerular basement membrane, vacuolar degeneration in renal tubular epithelial cells, mild glomerular atrophy, and renal interstitial infiltration of lymphocytes and macrophages (Fig. ?(Fig.22). Open in a separate window Figure 1 Pathology of Skin biopsy (100 HE staining): epidermal hyperplasia with diffuse lymphocytes and scattered eosinophils around the blood vessels in the JNJ-10397049 dermis. Open in a separate window Figure 2 Pathology of kidney biopsy: (A: 400 HE staining; B: 400 PMSA staining) diffuse moderate hyperplasia existed among glomerular endothelial and mesangial cells; thicken glomerular basement membrane, vacuolar degeneration in renal tubular epithelial cells, mild glomerular atrophy, and lymphocytes and macrophages infiltration in renal interstitial. (C: 200 immunofluorescence staining; D: 400 immunofluorescence staining) large amount of IgA deposited in mesangial matrix. After diagnosis, combination treatment with intravenous dexamethasone (5?mg/day) and oral ciclosporin (200?mg twice a day) was administered. The percentage of eosinophils in blood was significantly decreased from 0.13% to 0.00 within 11 days, and the patient’s symptoms of psoriasis and IgAN improved obviously. After 2-year follow-up, complete remission of the EP and partial remission of IgAN were detected with 6-month oral prednisone acetate (5?mg/day) consumption. 3.?Discussion Psoriasis is a chronic inflammatory disorder of the skin mediated by the immune system and can also affect the joints.[2] As renal dysfunction secondary to psoriasis is still controversial,.