Subject(s)
Embolism, Amniotic Fluid/microbiology , Enterobacteriaceae Infections/etiology , Morganella morganii/isolation & purification , Postoperative Complications/etiology , Shock, Septic/etiology , Cesarean Section , Combined Modality Therapy , Embolism, Amniotic Fluid/blood , Epilepsy, Generalized/etiology , Female , Hemoperitoneum/etiology , Hemoperitoneum/surgery , Hemostasis, Surgical , Humans , Hysterectomy , Meconium , Multiple Organ Failure/etiology , Postoperative Complications/microbiology , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/surgery , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/surgery , Pregnancy , Shock/etiology , Shock, Septic/microbiology , Shock, Septic/physiopathology , Splenectomy , Young AdultABSTRACT
BACKGROUND: Side-effects, including autoimmune disorders, are frequent with D-penicillamine therapy. Proteinuria is observed in 10% of the patients, often secondary to extramembranous glomerulopathy. Necrotizing extracapillary glomerulonephritis is however exceptional. CASE REPORTS: Two patients with systemic sclerodermia were treated with D-penicillamine for 7 and 14 years. Both developed necrotizing extracapillary glomerulonephritis with anti-myeloperoxidase antibodies (anti-MPO), associated with hemorrhagic alveolitis in one case. Partial regression of the renal failure was obtained after withdrawal of D-penicillamine and combination treatment with prednisone and cyclophosphamide. DISCUSSION: Extracapillary glomerulonephritis or a lung-kidney syndrome are frequently associated with anti-MPO antineutrophil cytoplasm antibodies (ANCA). In systemic sclerodermia, the presence of anti-MPO appears to define a group of patients at risk of pauci-immune extracapillary glomerulonephritis or a lung-kidney syndrome. In addition, the presence of ANCA in patients with renal failure would suggest extracapillary glomerulonephritis rather than sclerodermic microangiopathy. Development of extracapillary glomerulonephritis with anti-MPO in patients who are taking D-penicillamine suggests that inductor mechanisms other than D-penicillamine are involved in the pathogenesis of these glomerulopathies.
Subject(s)
Glomerulonephritis/immunology , Penicillamine/therapeutic use , Raynaud Disease/complications , Scleroderma, Systemic/complications , Aged , Antibodies, Antineutrophil Cytoplasmic/immunology , Autoimmune Diseases/chemically induced , Female , Glomerulonephritis/chemically induced , Humans , Middle Aged , Penicillamine/adverse effects , Proteinuria/chemically induced , Raynaud Disease/immunology , Scleroderma, Systemic/drug therapy , Scleroderma, Systemic/immunology , Sex FactorsABSTRACT
We report a case of acute respiratory distress with fatal outcome due to ictero-hemorrhagic leptospirosis. The association with an intra-alveolar hemorrhage suggested the corticosteroid therapy would be useful in this case.
