ABSTRACT
Pulmonary lymphangioleiomyomatosis is an interstitial lung disease with distinctive clinical, radiologic, physiological and pathological findings. We report an additional case of this rare condition, diagnosed on first medical evaluation by transbronchial lung biopsy and discuss the diagnostic approach.
Subject(s)
Lung Neoplasms/diagnosis , Lymphangioleiomyomatosis/diagnosis , Adult , Biopsy/methods , Bronchi , Diagnosis, Differential , Female , HumansABSTRACT
A patient developed an occlusion of both renal arteries by extension of a thrombosis of the infra-renal aorta to the superior mesenteric artery. He presented with classical features of acute renal ischemia: lumbar pain, nausea, vomiting, anuria. Since surgery and intra-arterial thrombolytic therapy were not feasible, we performed two peripheral intravenous (i.v.) perfusions of 50 mg Recombinant Tissue-Type Plasminogen Activator (r-tPA) given at 24 hours interval. During the next month serum creatinine decreased from 8.8 mg/dl to 2 mg/dl and the creatinine clearance rose from 0 to 20 ml/minute. The patient never required any dialysis. Seven months later his renal function remains stable.
Subject(s)
Acute Kidney Injury/etiology , Aortic Diseases/complications , Renal Artery Obstruction/complications , Thrombosis/complications , Angiography, Digital Subtraction , Aortic Diseases/diagnostic imaging , Aortography , Creatinine/blood , Heparin/therapeutic use , Humans , Male , Middle Aged , Renal Artery Obstruction/diagnostic imaging , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic useABSTRACT
Six days after initiating therapy with allopurinol, toxic epidermal necrolysis developed in a 73-year-old man with renal failure. It was responsible for a generalized vasculitis and gastrointestinal bleeding ultimately leading to death. The authors emphasize the need for a careful evaluation before prescribing this medication, particularly in patients with renal failure.