Insuficiencia renal aguda secundaria como manifestación inicial de favismo en un adulto mayor: Caso clínico / Favism presenting as an acute renal failure: Report of one case

Background: We report a 67-year-old man presenting with abdominal pain of acute onset, pallor, jaundice and behavioral changes after ingestion of fava beans. In the initial evaluation he appeared acutely ill and had resting dyspnea, edema and jaundice. His initial laboratory assessment disclosed azotemia, elevated lactate dehydrogenase levels, a low hemoglobin concentration (4.9 /dL) and a high corrected reticulocyte count (4,7%) with negative direct and indirect Coombs' test. The patient was transferred to the ICU, where he received support therapy with hemodialysis, mechanical ventilation, vasoactive drugs and transfusions of packed red cells. The evolution after 1 month was favorable and he was discharged without anemia and with normal renal function. Three months after discharge, the glucose-6-phosphate-dehydrogenase screening study did not demonstrate detectable enzymatic activity.

Clinical profile of children with favism

To describe the clinical picture of under five year children with favism including the severity of the disease and its treatment. The seasonal pattern is also examined. Design: Case series that reflects the investigator's own experience in handling cases of favism. Setting: Al-Khansah Maternity and Children Hospital in Mosul. All the cases are children with favism who were admitted to this main sick children hospital in Mosul during the period of one year from June 1992 to May 1993. Participants: Eighty-eight under five years old children of both sexes admitted to the hospital with favism. Clinical parameters measured: These children were managed as inpatients; being a retrospective study from their case records the following parameters were extracted: age, sex, date of onset [months], signs and symptoms, laboratory investigations and treatment given. The majority of cases [68%] were toddlers [one-four years], male: female ratio was 3: 4. All 88 children had dark colored urine and pallor. Jaundice was present in 3/4 of them while fever and vomiting were present in about half of the children. The months of April and May had witnessed the peak of the cases there was a second but less obvious peak in December. Six out of every ten patients were cases that required the ingestion of fava beans for several times before the acute hemolytic episode became clinically overt, while three out of ten children had the haemolysis after ingesting the beans for the first time. In one out of every ten children the present crisis was a recurrent one. One third of the children had a haemoglobin level of less than 5 g/dl, while in 77% of the cases the level was less than 7g/dl. Serum total bilirubin mainly of the indirect one was high in all patients and ranged between 1.2 - 28.2 mg /dl, the blood urea and serum creatinine values were normal. All patients needed and received blood transfusion. All of them recovered within 2-3 days without complications. The ingestion or inhalation of fava beans by susceptible under five years children in northern Iraq appear to precipitate a severe haemolytic crisis which usually needs blood transfusion. To prevent such episodes early detection - during neonatal period - of glucose 6-phosphate dehydrogenase [G6PD] deficiency is called for