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Carbapenem resistant enterobacteriaceae as a cause of peritonitis in a peritoneal dialysis patient

cence staining showed positive for immunoglobulin M (IgM) and light chain lambda (Fig. 1, lower panel). Serum protein immunoelectrophoresis showed increased levels of IgM and free light chain lambda. The serum levels of IgM, free light chain kappa, and free light chain lambda were 32.7 g/L (reference range, 0.4–2.3 g/L), 63.21mg/L (reference range, 3.3–19.4mg/L), and 206.10mg/L (reference range, 5.71–26.30mg/L), respectively. This patient was treated with a combination of rituximab, cyclophosphamide, vincristine and prednisone. After a total of eight courses of chemotherapy, the laboratory data were as follows: serum creatinine, 133μmol/L; albumin, 38 g/L; and IgM, 1.35 g/L. Protein concentration of random urine was 1.0 g/L. Waldenström macroglobulinaemia is a lymphoplasmacytic lymphoma associatedwith amonoclonal IgMprotein. Perirenal involvement of Waldenström macroglobulinaemia is an unusual manifestation, and it may present as nodules or a mass encasing the kidney by spread from retroperitoneal lymph nodes. Glomerular disorder is also a rare complication, and diverse pathological findings have been demonstrated including intracapillary thrombi, membranoproliferative glomerulonephritis, membranous nephropathy, and minimal change disease. Here, we present a rare instructive case of Waldenström macroglobulinaemia presenting as a large perirenal mass with nephrotic syndrome caused by FSGS.