ABSTRACT
This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.
Subject(s)
Acute Kidney Injury/etiology , Glomerulonephritis/drug therapy , Prednisolone/adverse effects , Steroids/adverse effects , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/diagnosis , Aged , Animals , Antiparasitic Agents/therapeutic use , Fatal Outcome , Female , Glomerulonephritis/diagnosis , Humans , Ivermectin/therapeutic use , Prednisolone/therapeutic use , Steroids/therapeutic use , Stomach/microbiology , Stomach/pathology , Strongyloidiasis/complications , Strongyloidiasis/drug therapyABSTRACT
HISTORY AND CLINICAL FINDINGS: A 36-year-old patient presented to the psychiatric clinic with presumed worsening of a chronic psychosis. INVESTIGATIONS: Laboratory values revealed acute renal failure and electrolyte imbalance. A further diagnostic work-up including urine analysis as well as abdominal und retroperitoneal sonography was normal. DIAGNOSIS, THERAPY AND CLINICAL COURSE: By exact history taking the clinical diagnosis of a cannabinoid hyperemesis syndrome (CHS) was established. Symptomatic treatment with intravenous fluids and electrolytes together with strict cannabis abstinence completely resolved all symptoms and normalized all pathologic values. CONCLUSION: Recreational use of cannabis is widespread. It may induce a widely unknown syndrome characterized by nausea, vomiting and crampy abdominal pain accompanied by frequent hot showers or bathing. This syndrome should be recognized as a potential cause of acute prerenal failure.
Subject(s)
Acute Kidney Injury/chemically induced , Dronabinol/toxicity , Marijuana Abuse/complications , Psychotropic Drugs/toxicity , Vomiting/chemically induced , Acute Kidney Injury/diagnosis , Adult , Diagnosis, Differential , Humans , Kidney Function Tests , Male , Marijuana Abuse/diagnosis , Schizophrenia, Paranoid/diagnosis , Water-Electrolyte Imbalance/chemically induced , Water-Electrolyte Imbalance/diagnosisABSTRACT
A 41-year-old woman presented with acute angina in the emergency unit. Additionally, she reported pain in both legs and a weight loss of 5 kilograms within the last 10 days. ECG revealed an acute anterior myocardial infarction. However, immediate coronary angiography showed open arteries with minimal arteriosclerosis. A characteristic rise of cardiac enzymes together with an akinesis of the anterior wall and an adjacent mural thrombus was highly suggestive of a transient coronary thrombosis. Further investigations showed occlusion of multiple arteries in both legs and a splenic infarct. Although there was a typical risk profile including smoking, hyperlipidemia and regular estrogen medication, a further work-up was started. Urin analysis was decisive for the presence of proteinuria and a severe nephrotic syndrome. The definite diagnosis was made by direct biopsy of the kidney that revealed the characteristic findings of a minimal change glomerulopathy. Rapid remission could be induced by high-dose oral steroids. During routine work-up of coronary syndromes, especially in those with normal coronaries, rare but treatable causes of myocardial infarction and coagulopathy have to be thought of and should carefully be excluded.