Case 29-2000

Presentation of CaseA 69-year-old woman was admitted to the hospital because of weakness, cough, and low-grade fever.The patient had end-stage renal disease due to membranous glomerulonephritis (Figure 1 and Figure 2) and a long history of hypertension. Four years before admission, after having undergone extracorporeal hemodialysis for three years, she received a cadaveric renal transplant, which was rejected because of the development of focal segmental glomerulosclerosis. Transplantation of a second cadaveric kidney was performed 34 months before admission. There were no episodes of rejection, and the creatinine level was approximately 2 mg per deciliter (180 μmol per liter). A chest . . .