{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T14:09:33Z","timestamp":1779804573134,"version":"3.53.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complement-mediated thrombotic microangiopathy (CM-TMA) results from dysregulated alternative pathway activation. Although extra-renal manifestations are well-recognized, presentation as a pancreatic mass is exceedingly rare and risks misdiagnosis as malignancy, delaying critical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 28-year-old male presented with malignant hypertension and rapidly progressive renal impairment. Abdominal CT revealed a pancreatic tail mass suspicious for neoplasia. However, histopathology of both renal and pancreatic tissues demonstrated microvascular thrombosis and endothelial injury, pointing to a systemic TMA process. Subsequent genetic testing confirmed pathogenic variants in CFH (p.Tyr1058His, p.Val1060Leu) and THBD (p.Asp486Tyr), establishing the diagnosis of CM-TMA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Treatment was initiated with eculizumab alongside intensive renin-angiotensin system blockade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>After 6\u202fmonths of therapy, renal function recovered and the pancreatic mass completely resolved. However, 3\u202fmonths after self-discontinuing eculizumab, the patient experienced a severe disease relapse and subsequently entered maintenance hemodialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This first histopathologically confirmed case of adult CM-TMA presenting as a pancreatic mass expands the known phenotype of complement-mediated disease. It highlights that in young adults with unexplained malignant hypertension and multisystem involvement, prompt evaluation for complement abnormalities is critical. The presence of high-risk complement variants and the relapse following treatment cessation underscore the necessity for long-term complement inhibition in such patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1766086","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:55:41Z","timestamp":1778129741000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Complement-mediated thrombotic microangiopathy masquerading as a pancreatic mass"],"prefix":"10.3389","volume":"13","author":[{"given":"Chuanchuan","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Nephrology, Peking University International Hospital","place":["Beijing, China"]},{"name":"Public Health and Preventive Medicine of Peking University School of Public Health, Peking University","place":["Beijing, China"]},{"name":"National Institute of Health Data Science, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Second Medical Center of PLA General Hospital, National Clinical Research Center for Geriatric Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Beijing Aerospace General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfei","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Peking University International 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