A case of palpable purpura and nephropathy: Occam's Razor or Hickam's Dictum.
Am J Ther
; 20(5): 572-5, 2013.
Article
en En
| MEDLINE
| ID: mdl-21248615
ABSTRACT
Vasculitis causing palpable purpura, nephropathy, and hematologic abnormalities is a well-known entity. However, sometimes, vasculitis may not be the primary cause but is part of a systemic disease. Literature suggests that infections like HIV can induce nephropathy and antineutrophilic cytoplasmic antibody-positive vasculitis, which is different from the well-known entity of "antineutrophilic cytoplasmic antibody-associated vasculitis." We present a 46-year-old female patient with a history of intravenous drug abuse who reported with a rash, swelling, and palpable purpura of the lower extremities. Peripheral smear showed no evidence of disseminated intravascular coagulation or thrombotic thrombocytopenic purpura; metabolic profile showed acute kidney injury. She was found to be HIV- and hepatitis C-positive. Immunologic workup was positive for both MPO and PR3 antineutrophilic cytoplasmic antibodies and negative for cryoglobulins; complement levels were low. Skin biopsy showed leukocytoclastic vasculitis but kidney biopsy was negative for any immunologic involvement; it showed only glomerulosclerosis. Thus, it was thought that nephropathy and vasculitis, in this case, are two distinct pathologic processes, both induced by infection (HIV and/or hepatitis C). The patient responded to low-dose steroid therapy. She was later started on the definitive therapy, the highly active antiretroviral therapy regimen. This case illustrates the fact that low-dose steroids can still be a good alternative in acute situations in patients at risk from immunosuppression.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Púrpura
/
Vasculitis
/
Infecciones por VIH
/
Hepatitis C
/
Enfermedades Renales
Tipo de estudio:
Diagnostic_studies
Límite:
Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
Am J Ther
Asunto de la revista:
TERAPEUTICA
Año:
2013
Tipo del documento:
Article
País de afiliación:
Israel