[Catastrophic antiphospholipid syndrome after ovulation induction]. / Syndrome catastrophique des antiphospholipides après induction d'ovulation.

INTRODUCTION: The catastrophic antiphospholipid syndrome (CAPS) is a rare expression of the antiphospholipid syndrome (APLS). The all predicting factors of happening of CAPS are not yet discovered. Some women presenting an APLS with infertility have recourse to ovulation induction (OI). EXEGESIS: After an OI, a woman is admitted for acute renal failure, hypertension, seizures, respiratory failure. History and immunologic tests are in favour of APLS. Renal biopsy highlights a thrombotic microangiopathy. Diagnosis of CAPS is made. Patient improves after respiratory assistance, parenteral treatment for hypertension and anticoagulant therapy. CONCLUSION: IO seems to be on of the factors which leads to CAPS. To avoid such consequences, it's essential to know the history and the immunological status of the patients having recourse to this treatment to take care of these risked pregnancies.

Renal involvement in POEMS syndrome.

We describe a patient with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) who was found to have renal involvement with particular renal pathological findings. So far, 17 other cases, most of them from Japan, of POEMS syndrome with renal involvement, have been published. Clinical features are variable: acute renal failure with anasarca or moderate chronic renal insufficiency with mild proteinuria. This latter presentation often passes unnoticed. There is no severe hypertension, no microangiopathic hemolytic anemia. Renal biopsy shows prominent glomerular changes which are unusual and distinct from membranoproliferative glomerulonephritis (MPGN) and from glomerular thrombotic microangiopathy (TMA). Mesangial proliferation and thickening of the capillary wall with double contour on light microscopy suggest an MPGN. By immunofluorescent microscopy, no immunoglobulins or complement deposits were found. The occurrence of mesangiolytic lesions has led to the term of "mesangiolytic glomerulonephritis". The presence, on electron microscopy, of lucent subendothelial spaces could indicate TMA. But there are neither thrombi nor arteriolar changes. We are inclined to consider that the microangiopathic lesions are due to chronic injury of glomerular endothelial cells, exacerbated at outbreaks of the disease. Increased production of IL 6 could support the efficacy of corticosteroid therapy, particularly in acute clinical situations.

[Outcome of acute renal failure caused by voluntary ingestion of Cortinarius orellanus]. / Evolution d'une insuffisance rénale aiguë par ingestion volontaire de Cortinarius orellanus.

Orellanin poisoning is characterized by an acute renal failure which can be lethal if the appropriate treatment is not given. A 31-year old woman was admitted to hospital 10 days after she had deliberately ingested 2 raw carpophores of the mushroom Cortinarius orellanus. Acute renal failure (creatininaemia 1,100 mumol/l) developed, requiring 6 sessions of haemodialysis, one of plasmapheresis and the administration of diltiazem and aminoacids. Plasma and tissue assays of orellanin, the mushroom's toxin, were performed by two-dimensional thin layer chromatography. Before haemodialysis and 10 days after ingestion of the poison, the plasma contained orellanin. Eighteen months after the attempted suicide, the plasma creatinine level was 181 mumol/l.

Intoxication by Cortinarius orellanus: detection and assay of orellanine in biological fluids and renal biopsies.

A woman suffering from acute tubulo-interstitial nephritis was admitted to the hospital ten days after deliberate intoxication by ingestion of Cortinarius orellanus. Orellanine, the main toxin responsible for orellanine poisoning, was detected in biological fluids and renal biopsies. It was assayed by direct spectrofluorimetry on two-dimensional thin-layer chromatograms after specific photodecomposition into orelline. The orellanine concentration was 6.12 mg/l in the plasma (10 days after ingestion). Orellanine levels in renal biopsies were 7 micrograms per 25 mm3 of the first biopsy (13 days after ingestion) and 24 micrograms per 8 mm3 of the second biopsy (6 months later).

Toxic reactions induced by hymenoptera venom.

A man experienced a toxic reaction after being stung simultaneously by 175 yellow jackets. After an initial minor anaphylactoid shock he presented a delayed acute renal failure secondary to intravascular hemolysis and rhabdomyolysis. He completely recovered without sequellae after hemodialysis. A second clinical case of hymenoptera venom-induced toxic reaction is presented. A woman was stung by 65 bees at the same time and she only had minor symptoms of anaphylactoid shock associated with an extensive angioedema. No symptom of acute renal failure, myolysis or hemolysis could be detected.

[Voluntary poisoning by Cortinarius orellanus: usefulness of an original early treatment after determination of orellanine in the biological fluids and tissues]. / Intoxication volontaire par Cortinarius orellanus: intérêt d'un traitement précoce original après dosage de l'orellanine dans les milieux biologiques et tissulaires.

Cortinarius poisoning is generally caused by orellanine, a hydroxy bipyridine N, N-dioxide. This intoxication is characterized by acute nephritis which can lead to death without treatment. We reported a highly sensitive and simple fluorimetric technique to analyse orellanine by thin-layer chromatography on the basis of its characteristic photodecomposition into orelline. Using this procedure, we detected and assayed orellanine for the first time in plasma and renal biopsies of a woman who had deliberately ingested two fruit-bodies of Cortinarius orellanus. An early original treatment was carried out based on hemodialysis, combination plasmapheresis-hemoperfusion, and amino acids and diltiazem administration. These results indicate that it is now possible to make a precise diagnosis of orellanine poisoning.