RESUMEN
Adult Still's disease (ASD) is a rare systemic disorder characterized by fever, arthralgia, cutaneous rash, and lymphadenopathy, with high polymorphonuclear leucocytosis and low glycosylated ferritinaemia. Kidney involvement has been reported rarely. We present a patient with ASD who developed haemolytic uraemic syndrome (HUS). The 42-year-old patient was admitted for unexplained fever related to ASD according to Yamaguchi's classification criteria. As Still's disease was resistant to prednisone, high-dose intravenous immunoglobulins (IV Ig) were administered. During the follow-up the patient developed acute renal failure and non-immune haemolytic anaemia with high levels of antiphospholipid antibodies (IgG anticardiolipin antibodies and anti-beta2 glycoprotein 1 antibodies). Renal biopsy disclosed thrombotic microangiopathy (TMA) with arteriolar and glomerular involvement. Treatment with steroids and intravenous IV Ig was reinitiated but renal function worsened towards end-stage renal failure. In this case, we suggest that antiphospholipid antibodies could have promoted arteriolar and glomerular TMA. HUS may be the cause of acute renal failure in Still's disease.
Asunto(s)
Lesión Renal Aguda/etiología , Síndrome Hemolítico-Urémico/etiología , Enfermedad de Still del Adulto/complicaciones , Trombosis/etiología , Lesión Renal Aguda/inmunología , Adulto , Anticuerpos Antifosfolípidos/inmunología , Síndrome Hemolítico-Urémico/inmunología , Humanos , Inmunoglobulinas Intravenosas , Masculino , Microcirculación , Circulación Renal , Esteroides/uso terapéutico , Enfermedad de Still del Adulto/tratamiento farmacológico , Enfermedad de Still del Adulto/inmunología , Trombosis/inmunologíaAsunto(s)
Hiponatremia/diagnóstico , Hipopituitarismo/diagnóstico , Trastornos Puerperales/diagnóstico , Enfermedad Aguda , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Hiponatremia/complicaciones , Síndrome de Secreción Inadecuada de ADH/etiología , Complicaciones del Trabajo de Parto , Embarazo , Hemorragia Uterina/etiologíaRESUMEN
Intravesical Bacillus Calmette-Guerin has proved to be the most effective treatment of superficial bladder carcinoma. This therapy may induce a renal failure of variable severity, sometimes associated with multiple organ failure. Renal prognosis of this complication is not well defined. We report on a 68 year-old male patient who developed granulomatous hepatitis and acute tubulo-interstitial nephritis with mononuclear infiltrates containing numerous epithelioid cells, following the third course of intravesical BCG. Eleven cases of renal impairment due to intravesical BCG have been previously described, as part of a systemic disease in seven patients. The potential pathophysiological mechanisms of this rare complication are precised.