A case of mistaken identity: fibrillary glomerulonephritis masquerading as crescentic anti-glomerular basement membrane disease.

Fibrillary glomerulonephritis (FGN) is a rare cause of rapidly progressive glomerulonephritis (RPGN). We report a case of FGN in which the patient presented with a clinical pulmonary-renal syndrome and whose kidney biopsy showed > 90% crescents on light microscopy. Immunofluorescence microscopy showed pseudo-linear IgG and C3 staining of the glomerular capillary walls resulting in an initial diagnosis of crescentic glomerulonephritis of anti-glomerular basement membrane (anti-GBM) antibody etiology. Electron microscopy showed fibrillary deposits permeating the glomerular capillary walls, characteristic of FGN. Although dialysis dependent at presentation and anuric at discharge, the patient recovered adequate renal function and urine output to come off dialysis at 20 weeks. A follow up biopsy performed at this stage showed progression of the underlying chronic kidney disease. This is the third reported case of FGN with a clinical presentation and histologic and immunofluorescence microscopic findings that closely mimicked anti-GBM antibody mediated disease. These cases demonstrate that FGN is a rare but important consideration in the differential diagnosis of RPGN.

Successful coronary intervention of circumflex artery originating from an anomalous left main coronary artery using a novel support catheter: a case report and review of literature.

Anomalous coronary arteries pose a great challenge during percutaneous intervention due to various technical factors. Inadequate guide support leads to significant obstacles for delivery of interventional devices to stenotic areas. Several methods have been proposed to overcome these obstacles. We present a novel technique where we used the Guideliner support catheter (Vascular Solutions, Inc.) to successfully intervene on a left circumflex coronary artery arising from a left main coronary artery anomalously arising from the right sinus of Valsalva.

Bacteraemia from an unrecognized source (occult bacteraemia) occurring during Clostridium difficile infection.

BACKGROUND: The purpose of this investigation was to determine if disruption of the colonic epithelium during Clostridium difficile infection (CDI) is associated with bacteraemia due to secondary bacterial invasion by enteric organisms. METHODS: We reviewed the medical records of 505 randomly selected individuals from a database of patients who tested positive for C. difficile toxin and identified bacteraemias that occurred in 2 periods-the pre-CDI and post-CDI periods. Medical records were reviewed to determine a source for each case of bacteraemia. Staphylococcal bacteraemias were excluded from the analysis. RESULTS: In the pre-CDI period, 28 of 505 (5.5%) patients had non-staphylococcal bacteraemia. A focus of infection was found in 24 of 28 (85.7%) cases. During CDI, 30 of 505 (5.9%) patients had non-staphylococcal bacteraemia; in the majority (19 cases, 63.3%) a focus of infection was not identified (p < 0.001). In the pre-CDI period, 16 of 28 (57.1%) blood cultures yielded Gram-negative pathogens compared to 9 of 30 (30%) in the CDI period (p = 0.04). Seven of 28 (25%) blood cultures in the pre-CDI period yielded enterococci compared to 15 of 30 (50%) in the CDI period (p = 0.05). CONCLUSIONS: The incidence of non-staphylococcal bacteraemias in the pre- and post-CDI periods was nearly the same. Cases of bacteraemias in the CDI period more frequently involved organisms of unknown source and uncertain pathogenicity, and were usually not found to require antimicrobial therapy. The data favour the assumption that CDI-associated bacteraemia may be associated with bacterial invasion of the damaged colonic epithelium.