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1.
Neurol Sci ; 43(3): 1499-1502, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35001190

RESUMO

We report a case of massive cerebral venous sinus thrombosis in the contest of vaccine-induced immune thrombotic thrombocytopenia that required the rapid coordination of many specialists from different departments, notably emergency, neurology, neuroradiology, hematology, and neurosurgery. The patient was rapidly treated with steroids, immunoglobulin, and fondaparinux. She underwent within 6 h after hospital admission a mechanical thrombectomy in order to allow flow restoration in cerebral venous systems. Neuroendovascular treatment in cerebral venous thrombosis related to VITT has never been described before. It can represent a complementary tool along with the other therapies and a multidisciplinary approach.


Assuntos
COVID-19 , Trombose dos Seios Intracranianos , Trombocitopenia , Vacinas , Vacinas contra COVID-19 , ChAdOx1 nCoV-19 , Feminino , Humanos , Trombose dos Seios Intracranianos/induzido quimicamente , Trombose dos Seios Intracranianos/diagnóstico por imagem , Vacinas/efeitos adversos
3.
Front Med (Lausanne) ; 7: 587345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33392216

RESUMO

Monoclonal Gammopathy of Renal Significance (MGRS) is a group of heterogeneous disorders characterized by renal dysfunction secondary to the production of a monoclonal immunoglobulin by a nonmalignant B cell or plasma cell clone. We report the clinical and histological outcomes of two patients with biopsy-proven MGRS: one patient showed membranoproliferative glomerulonephritis with monoclonal k-light chain and C3 deposits, the second patient showed immunotactoid glomerulopathy. Both patients were treated with a 9-month chemotherapy protocol including bortezomib, cyclophosphamide, and dexamethasone. Renal biospy was repeated after 1 year. The estimated glomerular filtration rate (eGFR) increased from 22.5 (baseline) to 40 ml/min per 1.73 m2 after 12 months, then to 51.5 ml/min per 1.73 m2 after 24 months; proteinuria decreased from 4.85 (baseline) to 0.17 g/day after 12 months, then to 0.14 g/day after 24 months. Repeat renal biopsies showed a dramatic improvement of the glomerular proliferative lesions and near complete disappearance of the immune deposits. A bortezomib-based treatment proved very effective and was well-tolerated in the two patients presenting with clinically and histologically aggressive MGRS.

4.
G Ital Nefrol ; 36(4)2019 Jul 24.
Artigo em Italiano | MEDLINE | ID: mdl-31373468

RESUMO

In the last few years, the increasing awareness of the complex interaction between monoclonal component and renal damage has determined not only a new classification of the associated disorders, called Monoclonal Gammopathy of Renal Significance (MGRS), but has also contributed to emphasize the importance of an early diagnosis of the renal involvement, which is often hard to detect but can evolve towards terminal uraemia; it has also pointed at the need to treat these disorders with aggressive regimens, even if they are not strictly neoplastic. The case described here presented urinary abnormalities and renal failure secondary to a membranoproliferative glomerulonephritis (MPGN), with intensively positive immunofluorescence (IF) for monoclonal k light chain and C3, and in the absence of a neoplastic lympho-proliferative disorder documented on bone marrow biopsy. After the final diagnosis of MGRS, the patient was treated with several cycles of a therapy including dexamethasone, cyclophosphamide and bortezomib, showing a good functional and clinical response.


Assuntos
Glomerulonefrite Membranoproliferativa/complicações , Paraproteinemias/complicações , Insuficiência Renal/etiologia , Biópsia , Bortezomib/uso terapêutico , Complemento C3c , Ciclofosfamida/uso terapêutico , Dexametasona/uso terapêutico , Diagnóstico Precoce , Feminino , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulonefrite Membranoproliferativa/patologia , Glucocorticoides/uso terapêutico , Humanos , Cadeias kappa de Imunoglobulina , Glomérulos Renais/patologia , Glomérulos Renais/ultraestrutura , Pessoa de Meia-Idade , Paraproteinemias/tratamento farmacológico
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