ABSTRACT
Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by lymphocytic and plasmacytic infiltration of the exocrine glands. Tubulointerstitial nephritis (TIN) is the most common type of renal involvement in pSS. However, clinically significant renal involvement is uncommon. Granulomatous interstitial nephritis (GIN) is a rare histopathological entity characterized by the presence of granulomas against a background of interstitial inflammation. GIN is not a typical and commonly seen form of TIN in pSS. Herein, we report on a patient who was concurrently diagnosed with pSS and GIN and was treated successfully with rituximab (RTX). pSS should be considered in the differential diagnosis of GIN, and RTX may be a good option in the treatment of this patient group.
Subject(s)
Glomerulonephritis/drug therapy , Glomerulonephritis/pathology , Nephritis, Interstitial/drug therapy , Nephritis, Interstitial/pathology , Rituximab/administration & dosage , Sjogren's Syndrome/drug therapy , Sjogren's Syndrome/pathology , Adult , Anti-Inflammatory Agents/administration & dosage , Diagnosis, Differential , Female , Humans , Immunologic Factors/administration & dosage , Treatment OutcomeSubject(s)
Arthritis, Rheumatoid/drug therapy , Cyclophosphamide/adverse effects , Scleritis/chemically induced , Administration, Oral , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Dose-Response Relationship, Drug , Female , Humans , Middle Aged , Scleritis/diagnosis , Withholding TreatmentABSTRACT
BACKGROUND: Ciprofloxacin-associated seizures (CAS) occur most commonly in patients with special risk factors that may cause accumulation of drug (high doses of the drug, old age, renal insufficiency, drug interactions) or that may decrease the threshold of epileptogenic activity (electrolyte abnormalities, history of seizures, electroconvulsive therapy). OBJECTIVE: To report thyrotoxicosis as a risk factor previously not heralded for the development of CAS. CASE SUMMARY: A 24-year-old woman was admitted to the hospital because of convulsions, severe myopathy, and acute renal failure after taking ciprofloxacin for sinusitis, and urinary tract infections. Prior to ciprofloxacin ingestion, she had no seizure history, was not receiving any other medication, and her routine laboratory results including creatinine and electrolytes were within normal ranges. Electroencephalogram suggested epileptiform waves. Cranial magnetic resonance imaging was normal. Further laboratory examinations documented thyrotoxicosis in association with postpartum thyroiditis. DISCUSSION: In the reviewed literature, all cases of CAS occurred in the presence of at least one risk factor for CAS. CONCLUSIONS: CAS appear to be restricted to individuals with predisposing risk factors, therefore it is always necessary to search such fact. When a physician encounters the possibility of CAS, in addition to previously described risk factors, thyrotoxicosis should also be considered in the differential diagnosis. Further, in patients with untreated thyrotoxicosis, antibiotics other than ciprofloxacin might be preferable for therapy.
