Unexpected Death from Hemorrhagic Pericarditis Complicating IgA Nephropathy

Abstract

IgA nephropathy is the most common cause of glomerulonephritis in the developed world; however, it is usually an indolent or slowly progressive disease presenting initially as self-limited hematuria, typically following a viral or bacterial infection. We report a case of previously undiagnosed IgA nephropathy manifesting with end stage renal disease, fibrinous pericarditis, and hemorrhagic pericardial effusion in a 26-year-old white male. Clinical manifestations of IgA nephropathy, the presumed pathogenesis, and complications are reviewed. This case highlights the importance of interdisciplinary collaborations with other specialized pathology services—in this case renal pathology, including direct immunofluorescence and electron microscopy—that may not be routinely available or used in forensic pathology practices. In this instance, such collaboration provided the etiologically specific diagnosis for an unusual presentation of a common disease.