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Membranous glomerulonephritis, dermatomyositis, and bronchial carcinoma Membranous glomerulonephritis is associated with malignant disease in about 100° , of cases.'The prevalence of neoplasia in patients with dermatomyositis is estimated at 15-20%o in those aged over 45.2The occurrence of membranous glomerulonephritis with dermato- myositis is extremely unusual and in the one documented case malig- nancy was not implicated.3Case report A woman aged 58 years presented with ankle swelling and proteinuria..She smoked 20-30 cigarettes a day, was taking no medication, and was normotensive.Urine microscopy showed red cells with granular and cellular casts.The proteinuria was selective and amounted to 5-2 g/24 h.Serum con- centrations were as follows: albumnin 25 g/l, urea 6-8 mmol/l (41 mg/100 ml), and creatinine 129 /umol/l (1-46 mg/100 ml), ESR 50 mm in 1 h, and C3 1-28 U (0-8-1-4).A renal biopsy specimen showed diffuse capillary loop thickening and basement membrane spikes (figure).Immunofluorescence showed granular Renal glomerulus showing basement membrane spikes.Silver stain x 350 (original magnification).IgG deposition along capillary loops.The features were typical of mem- branous glomerulonephritis.Treatment with frusemide was started.Three years later she developed dermatomyositis with periorbital oedema; dusky erythema of the face, trunk, and hands; proximal muscle weakness; and dysphagia.The serum concentration of creatinine phosphokinase was 290 U/I (10-60), aldolase 3-6 U/I (0-5-3 0), and lactate dehydrogenase 760 U/l (50-220).The proteinuria had diminished to 0 7 g/24 h, and serum concentration of albumin was 29 g/l, urea 9 mmol/l (54 mg/100 ml), creatinine 105 ,jmol/l (1.1 mg/100 ml), and ESR 60 mm in 1 h.Antinuclear anti- body was not detected.A chest radiograph was normal but lung tomography showed a 1-cm opacity in the right mid-zone.An oat cell tumour was later resected with the upper lobe.Preoperative treatment with prednisone and azathioprine dramatically improved the dermatomyositis and this improve- ment was sustained when the drugs were stopped postoperatively.