[Idiopathic eosinophilia with ascites (case report)]. / Idiopatska eozinofilija s ascitesom (prikaz bolesnika).

Hypereosinophilia can present a diagnostic problem if initial diagnostic procedures (medical history, physical examination and basic laboratory exams) fail to reveal the cause. Persistent finding of hypereosinophilia in such patients demands diagnostic intervention in order to rule out neoplastic and lymphoproliferative diseases, chronic inflammatory diseases of respiratory and gastrointestinal system and skin, and other inflammatory and postinflammatory conditions. If these disorders are ruled out, consideration should also be given to the diagnosis of primary hypereosinophilia, including idiopathic hypereosinophilic syndrome. The paper presents a patient with significant elevation of absolute and relative numbers of eosinophils in whom the only physical pathologic finding was eosinophilic ascites. Extensive diagnostic investigation did not prove secondary character of abnormalities, and since all pathologic findings receded during 7-month observation without treatment, the conclusion was that the disorder was benign.

[Intermittent intravenous cyclophosphamide application in patients with systemic lupus erythematosus]. / Intermitentna intravenska primjena ciklofosfamida u bolesnika sa sustavnim eritemskim lupusom.

The aim of this paper is retrospective analysis of data from patients in whom the indication for cyclophosphamide (CF) pulse therapy was established in our department. Indications for CF pulse treatment were lupus nephritis (LN) alone or associated with central nervous system lupus. CF was administred in the dose of 500-1000 mg/m2 intravenously once monthly for the 6 months and once every 3 months thereafter. Patients were treated with adequate dose of glucocorticoids and other symptomatic therapy. The effect of applied therapy has been analysed by monitoring proteinuria, serum creatinine concentration, creatinine clearance, ESR, ANF titer and total complement hemolytic activity. Initial therapeutic procedure has been completed in 25/30 patients. The reasons for discontinuation in 5/30 patients were as follows: end-stage renal failure in spite of therapy (1), psychosis and lost of compliance (1), recurrent pancytopenia and subsequent sepsis (1), death non related to SLE (1) and failure to show at follow-up (1). Significant improvement of all control parameters was observed in the majority of patients in whom the therapy was completely conducted. 16/25 patients continued therapy for the next 18 months and in only 1/16 patients therapy was discontinued because of end-stage renal failure. In other 15/16 patients further improvement of control parameters was observed, although not so expressed as in the first 6 months. The most frequent complications were infections (16 infections were microbiologically proved and there were probably more infections). Alopecia (2), haematuria (1) and amenorrhoea (1) were also observed. Relatively low incidence of complications may be explained by careful patient monitoring. Considering that therapeutic success is defined not only by the improvement of renal function, but by stopping of further progression of renal failure, it can be concluded that intermittent CF pulse therapy showed good effect on LN in patients with clear indication.