scholarly journals Microscopic Polyangiitis following Silicone Exposure from Breast Implantation

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Judy Tan ◽  
Fuad Spath ◽  
Rakesh Malhotra ◽  
Zaher Hamadeh ◽  
Anjali Acharya
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Renal Biopsy ◽  
Clinical Response ◽  
Crescentic Glomerulonephritis ◽  
Microscopic Polyangiitis ◽  
Pulmonary Hemorrhage ◽  
High Dose ◽  
Breast Implantation ◽  
Silicone Breast Implantation

We describe a case of a patient who developed microscopic polyangiitis (MPA) in the setting of exposure to silicone after breast implantation. A 57-year-old Hispanic woman was admitted to our hospital with complaints of fever, cough, and hemoptysis. She had undergone silicone breast implantation two years prior to presentation. She was diagnosed as having microscopic polyangiitis (MPA) based on acute progressive renal failure, hematuria, pulmonary hemorrhage, and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA). A renal biopsy performed showed focal segmental necrotizing and crescentic glomerulonephritis. The patient received high dose steroids, cyclophosphamide, and plasmapheresis with remarkable clinical response. This case report raises the possibility of the development of MPA after silicone exposure from breast implantation.

scholarly journals Top Differential Diagnosis Should Be Microscopic Polyangiitis in ANCA-Positive Patient with Diffuse Pulmonary Hemorrhage and Hemosiderosis

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Nicholas D. Ward ◽  
Diane E. Cosner ◽  
Colleen A. Lamb ◽  
Wei Li ◽  
Jacqueline K. Macknis ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Renal Biopsy ◽  
Lung Biopsy ◽  
Crescentic Glomerulonephritis ◽  
Microscopic Polyangiitis ◽  
Pulmonary Hemorrhage ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Giant Cells ◽  
Positive Patient ◽  
Neutrophil Aggregation

A rat model of antineutrophil cytoplasmic antibody (ANCA) associated vasculitides reveals crescentic glomerulonephritis as seen in human renal biopsies and diffuse lung hemorrhage that is not well documented in human lung biopsies. A 64-year-old male, with shortness of breath and mild elevation of serum creatinine, was found to have a positive serum test for ANCA, but negative antiglomerular basement membrane antibody. A renal biopsy showed pauci-immune type of crescentic glomerulonephritis and focal arteritis. The prior lung wedge biopsy was retrospectively reviewed to show diffuse hemorrhage and hemosiderosis with focal giant cells. In addition, small arteries revealed subtle neutrophil aggregation, and margination along vascular endothelium, but no definitive vasculitis. The pathology of ANCA associated vasculitides results from activated neutrophils by ANCA and subsequent activation of the alternative complement cascade with endothelial injury, neutrophil aggregation and margination. Our findings, after the correlation between lung biopsy and renal biopsy, imply that the top differential diagnosis in the lung biopsy should be microscopic polyangiitis when diffuse pulmonary hemorrhage and hemosiderosis are present in this ANCA-positive patient.

scholarly journals Preeclampsia, HELLP Syndrome, and Postpartum Renal Failure with Thin Basement Membrane Nephropathy: Case Report and a Brief Review of Postpartum Renal Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
K. C. Janga ◽  
Pavani Chitamanni ◽  
Shraddha Raghavan ◽  
Kamlesh Kumar ◽  
Sheldon Greenberg ◽  
...  
Keyword(s):  
Renal Failure ◽  
Basement Membrane ◽  
Renal Biopsy ◽  
Hellp Syndrome ◽  
Tubulointerstitial Nephritis ◽  
Laboratory Evaluation ◽  
High Dose ◽  
Acute Tubulointerstitial Nephritis ◽  
Thin Basement Membrane Nephropathy ◽  
First Case

A 36-year-old primigravida female from a birthing center was referred for elevated blood pressure to the hospital two days after normal spontaneous vaginal delivery with nausea, vomiting, and diarrhea. During this two-day period, she was experiencing persistent vaginal bleeding and lower abdominal pains for which she took six doses of 600 mg ibuprofen. Further laboratory evaluation reflected leukocytosis, anemia, thrombocytopenia, elevation of liver enzymes, and renal failure with hyperkalemia requiring emergent hemodialysis once in the Medical Intensive Care Unit (MICU). She was diagnosed with HELLP syndrome with underlying preeclampsia. A week later, due to hypertension controlled with medications and nonoliguric renal failure with no active urine sediments, a renal biopsy was indicated to direct management. The renal biopsy supported the diagnosis of diffuse severe acute tubulointerstitial nephritis with hypereosinophilia and thin basement membrane nephropathy (see figures). She was subsequently treated with high-dose steroids which resulted in the normalization of blood pressures and renal function returning to baseline. We report the first case of acute tubulointerstitial nephritis in an individual with thin basement membrane nephropathy secondary to postpartum complications.

scholarly journals Crescentic Glomerulonephritis with Anti-GBM and p-ANCA Antibodies

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Tariq Javed ◽  
Parag Vohra
Keyword(s):  
Renal Failure ◽  
Renal Biopsy ◽  
Recurrence Rate ◽  
Crescentic Glomerulonephritis ◽  
Diagnosis And Treatment ◽  
Atypical Presentation ◽  
Long Term Follow Up ◽  
Pulmonary Renal Syndrome

We are presenting a case of renal failure with anti-GBM and p-ANCA antibodies positive. Patients with dual antibodies are considered to be a vasculitis-variant of anti-GBM antibody nephritis. These patients may have atypical presentation and it may delay diagnosis and treatment. Recurrence rate is higher in these patients. We reviewed the literature of cases and studies on cresenteric glomerulonephritis with anti-GBM and p-ANCA positive patients. We recommend that patients suspected with pulmonary-renal syndrome should be checked for anti-GBM and p-ANCA antibodies, should undergo renal biopsy and should should have close long term follow up to watch for recurrence.

High-Dose Procainamide in Chronic Renal Failure

1983 ◽  
Vol 17 (4) ◽  
pp. 279-281
Author(s):  
Michael B. Bottorff ◽  
Chien Suu Kuo ◽  
Randal L. Batenhorst
Keyword(s):  
Renal Failure ◽  
Ventricular Tachycardia ◽  
Chronic Renal Failure ◽  
Clinical Response ◽  
Serum Levels ◽  
High Dose ◽  
Ventricular Ectopy

A patient with chronic renal failure who experienced symptomatic ventricular tachycardia was treated successfully with procainamide (PA) after numerous dosage adjustments to optimize his clinical response and serum PA and NAPA concentrations. Efforts to maintain total combined serum levels at 20–30 μg/ml led to sustained ventricular ectopy whenever the serum PA levels decreased to < 8 μg/ml.

Lupus Nephritis in Children—A Review of 167 Patients

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 335-340
Author(s):  
Ling-Yoeu Yang ◽  
Wei-Perng Chen ◽  
Ching-Yuang Lin
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Proliferative Glomerulonephritis ◽  
High Dose ◽  
Creatinine Concentration ◽  
Initial Biopsy ◽  
Class Iv

Background. Relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is ominous for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. Up to now few studies have been made on this subject. Objectives. To evaluate the clinical course, histopathology, and prognosis of lupus nephritis in children, to identify the risk factors for renal failure and mortality, and to share our experience in treating lupus nephritis in children. Methods. Retrospectively, 167 children under 18 years of age with lupus nephritis at Veterans General Hospital-Taipei, Taiwan from 1979 to 1991 were studied. All patients received renal biopsy and follow-up biopsies were performed in 36 children. The clinical and serologic parameters at the time of renal biopsy were recorded. Results. There were 55 (33%) patients with class II, 30 (18%) with class III, 69 (41.3%) with class IV, and 13 (7.8%) with class V nephritis based on initial biopsy. The mean follow-up time was 59 months. Follow-up biopsies were histologically stationary in 29 patients, progressive in five, and regressive in two. The results revealed that those with persistent hypertension, anemia, increased serum creatinine concentration, and decreased creatinine clearance rate at initial biopsy were more prone to develop renal failure. Low titer of CH50 hemolytic assay appeared to be a poor prognostic indicator. The overall renal and patient 5-year survival rates were 93.1% (135/145) and 91.08% (143/157), respectively. They were 87.7% (50/57) and 82% (55/67), respectively, of patients with class IV proliferative glomerulonephritis. Conclusions. The prognosis of children with class IV nephritis in this study was better than that reported previously. All children surviving without renal failure were maintaining their normal lives with little organ dysfunction. The improved results may be due to earlier renal biopsy for precise histopathologic definition, better supportive care, and selective use of aggressive therapy, including methylprednisolone pulse therapy, intravenous cyclophosphamide, intravenous prostaglandin E1 therapy, high-dose intravenous gammaglobulin therapy, and cyclosporin A for those with high risk factors.

scholarly journals 618. Fluconazole-Resistant Candida albicans Vaginitis with Cross-Resistance to Azoles: A Case Report

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S287-S288
Author(s):  
Damla Akdağ ◽  
Hüsnü Pullukçu ◽  
Tansu Yamazhan ◽  
Dilek Yesim Metin ◽  
Oğuz Reşat Sipahi ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Case Report ◽  
Clinical Response ◽  
Antifungal Susceptibility ◽  
Vaginal Swab ◽  
Vulvovaginal Candidiasis ◽  
Vaginal Candidiasis ◽  
Cross Resistance ◽  
High Dose

Abstract Background Local and systemic use of azole derivatives are common in the treatment of vulvovaginal candidiasis. However, there are cases unresponsive to these agents. Herein, we present treatment and follow-up of a patient with fluconazole–itraconazole and voriconazole-resistant recurrent vaginal candidiasis. Methods A 37-year-old woman with no comorbidity used topical and oral antifungal/antibacterial medications (including fluconazole and itraconazole) in the treatment of recurrent vulvovaginitis, was hospitalized due to continuous complaints. Intense, white-colored, odorless vaginal discharge was observed on physical examination. Urine and vaginal swab samples were taken for mycological and bacteriological culture. Metronidazole (500 mg 3x1 i.v.) and high dose fluconazole (600 mg/day i.v.) were initiated empirically for the possibility of dose-dependent resistant Candida infection, but there was no clinical response. Results Candida albicans was isolated in vaginal swab culture, but response to systemic fluconazole treatment for one week was inadequate. Antifungal susceptibility test was performed by microdilution method according to CLSI M27A3 guidelines and MIC values were reported respectively; fluconazole 4 µg/mL (SDD), itraconazole 1 µg/mL (R), posaconazole 0.06 µg/mL (WT), voriconazole 0.25 µg/mL (SDD), anidulafungin ≤ 0.015 µg/mL (S), amphotericin B 0.06 µg/mL (WT). For the resistance mechanism, point mutation in the ERG11 gene and MDR1 and MDR2 from efflux pumps were investigated and only the G464S mutation was detected in the ERG11 gene. Treatment was switched to IV anidulafungin (200 mg on day 1 followed by 100 mg/day). Clinical response was achieved in the patient whose complaints were reduced, and there was no Candida in the repeated vaginal swab culture taken on day 3 of treatment. The patient was discharged after 2 weeks of treatment. She had no recurrence after 2 years follow-up. Conclusion It should be kept in mind that resistant strains may be responsible for recurrent and unresponsive vulvovaginal candidiasis cases. Although there is no case report in which anidulafungin is used for treatment and it should be kept in mind that the anidulafungin is also in the treatment as it is summarized. Disclosures All authors: No reported disclosures.

Microscopic polyangiitis after silicone breast implantation

2005 ◽  
Vol 9 (3) ◽  
pp. 252-254 ◽  
Author(s):  
Masayuki Iyoda ◽  
Jyun Ito ◽  
Hisako Nagai ◽  
Kasumi Sato ◽  
Aki Kuroki ◽  
...  
Keyword(s):  
Microscopic Polyangiitis ◽  
Breast Implantation ◽  
Silicone Breast Implantation
Sign in / Sign up

Export Citation Format

Share Document