ABSTRACT
A 48-year-old woman with systemic sclerosis (SSc) and rheumatoid arthritis was admitted to our hospital because of renal dysfunction. She had no hypertension at the time of admission and mild hypertension for only one and a half months until the time of admission. After admission, she received angiotensin-converting enzyme-inhibitor, but her renal dysfunction did not improve. She then had thrombotic microangiopathy with thrombocytopenia, and was treated with plasma exchange five times, but her renal dysfunction persisted. The renal biopsy specimens showed an arteriosclerotic lesion with intimal thickening and luminal narrowing and ischemic glomerular changes. These findings suggest that there is chronic vascular injury in a patient who has no hypertension with SSc and that once hypertension supervenes, whether severe or not, exacerbation of the vascular injury and renal dysfunction may occur.
Subject(s)
Kidney Failure, Chronic/etiology , Kidney/pathology , Scleroderma, Systemic/complications , Arthritis, Rheumatoid/complications , Female , Humans , Kidney/blood supply , Kidney/ultrastructure , Middle Aged , Plasmapheresis , Scleroderma, Systemic/pathology , Scleroderma, Systemic/therapySubject(s)
Calcinosis/diagnostic imaging , Hyperparathyroidism/diagnosis , Mitral Valve/diagnostic imaging , Renal Dialysis/adverse effects , Tomography, X-Ray Computed/methods , Calcinosis/physiopathology , Follow-Up Studies , Humans , Hyperparathyroidism/surgery , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Long-Term Care , Male , Middle Aged , Mitral Valve/pathology , Parathyroidectomy , Renal Dialysis/methods , Risk AssessmentABSTRACT
Anemia is a common problem that results from various causes in patients with ulcerative colitis (UC), but there is little information on the association of UC with pure red cell aplasia (PRCA). We describe the first case of parvovirus-induced PRCA in UC. A 28-year-old woman with chronic UC was admitted to the hospital for treatment of active pancolitis. Three courses of pulse therapy with methylprednisolone provided complete remission. However, the patient developed reticulocytopenia and a subsequent fall in hemoglobin to 6.2 g/dl. Bone marrow examination revealed selective aplasia of red cell precursors and giant pronoromoblasts. Enzyme immunoassay identified specific immunoglobulin M antibody against parvovirus B19 in the serum. Based on these findings, the diagnosis of PRCA caused by the virus was made. The patient was treated with a 3-day course of intravenous immunoglobulin (5 g/day), resulting in brisk reticulocytosis, folowed by normalization of hemoglobin level. In conclusion, Chronic or acute blood loss in UC associated with enhanced red cell turnover might be a risk factor for PRCA when affected patients contract parvovirus B19 infection.
