RESUMO
Methylenedioxypyrovalerone (MDPV) is a synthetic, cathinone-derivative, central nervous system stimulant taken to produce a cocaine- or methamphetamine-like high. Physical manifestations include tachycardia, hypertension, arrhythmias, hyperthermia, sweating, rhabdomyolysis, hyperkalaemia, disseminated intravascular coagulation, oliguria and seizures. We report a patient who presented with severe metabolic acidosis, multi-organ dysfunction, rhabdomyolysis, hyperkalaemia and seizures. This case highlights that even though a urine drug screen for routine psychostimulant drugs is negative, clinicians need to be vigilant about the adverse effects of MDPV as a possible cause of multi-organ dysfunction. Substances such as this can only be detected by special tests, such as gas/liquid chromatography mass spectrometry. This is the first reported case of MDPV toxicity successfully treated in Australia to the best of our knowledge.
Assuntos
Benzodioxóis/intoxicação , Estimulantes do Sistema Nervoso Central/intoxicação , Drogas Desenhadas/intoxicação , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Insuficiência de Múltiplos Órgãos/terapia , Pirrolidinas/intoxicação , Adulto , Alcaloides/agonistas , Austrália , Febre/induzido quimicamente , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Terapia de Substituição Renal , Rabdomiólise/induzido quimicamente , Catinona SintéticaAssuntos
Ciclofosfamida/administração & dosagem , Glomerulonefrite , Glucocorticoides/administração & dosagem , Rim , Complicações na Gravidez , Rituximab/administração & dosagem , Aborto Induzido/métodos , Adulto , Anticorpos Anticitoplasma de Neutrófilos/análise , Antirreumáticos/administração & dosagem , Biópsia/métodos , Progressão da Doença , Feminino , Glomerulonefrite/diagnóstico , Glomerulonefrite/imunologia , Glomerulonefrite/fisiopatologia , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Testes de Função Renal/métodos , Microscopia Eletrônica/métodos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/imunologia , Complicações na Gravidez/fisiopatologia , Diálise Renal/métodos , Ultrassonografia/métodosAssuntos
Anuria/etiologia , Glomerulonefrite Membranoproliferativa/etiologia , Necrose Tubular Aguda/etiologia , Insuficiência Renal/etiologia , Macroglobulinemia de Waldenstrom/complicações , Idoso , Anuria/diagnóstico , Anuria/terapia , Biomarcadores/sangue , Biópsia , Creatinina/sangue , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulonefrite Membranoproliferativa/terapia , Hematúria/etiologia , Humanos , Necrose Tubular Aguda/diagnóstico , Necrose Tubular Aguda/terapia , Masculino , Valor Preditivo dos Testes , Insuficiência Renal/diagnóstico , Insuficiência Renal/terapia , Macroglobulinemia de Waldenstrom/diagnóstico , Macroglobulinemia de Waldenstrom/terapiaRESUMO
BACKGROUND: The overall incidence of Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients is 5-15%. A timely diagnosis of PJP is difficult and relies on imaging and detection of the organism. METHODS: We present a case series of four patients displaying hypercalcaemia with an eventual diagnosis of PJP and document the management of the outbreak with a multidisciplinary team approach. We discuss the underlying pathophysiology and previous reports of hypercalcaemia preceding a diagnosis of PJP. We also reviewed the evidence concerning PJP diagnosis and treatment. RESULTS: Within our renal transplant cohort, four patients presented within 7 months with hypercalcaemia followed by an eventual diagnosis of PJP. We measured their corrected calcium, parathyroid hormone (PTH), 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] and 25-hydroxycholecalciferol [25(OH)D] levels at admission and following treatment of PJP. All four patients diagnosed with PJP were 4-20 years post-transplantation. Three of the four patients demonstrated PTH-independent hypercalcaemia (corrected calcium >3.0 mmol/L). The presence of high 1,25(OH)2D3 and low 25(OH)D levels suggest negation of the negative feedback mechanism possibly due to an extrarenal source; in this case, the alveolar macrophages. All four patients had resolution of their hypercalcaemia after treatment of PJP. CONCLUSIONS: Given the outbreak of PJP in our renal transplant cohort, and based on previous experience from other units nationally, we implemented cohort-wide prophylaxis with trimethoprim-sulphamethoxazole for 12 months in consultation with our local infectious diseases unit. Within this period there have been no further local cases of PJP.