RESUMO
Acute kidney injury due to light chain cast nephropathy is increasingly recognised in patients with haematological malignancies; however, the management and prognosis of this disease remain poorly understood. We describe a case of a 78-year-old woman with known chronic lymphocytic leukaemia (CLL) who presented with fatigue and weight loss. She was found to have acute kidney injury, which rapidly worsened during admission. Kidney biopsy showed light chain cast nephropathy and bone marrow biopsy confirmed B-cell CLL. She was started on ibrutinib, halting further deterioration in her renal function and avoiding renal replacement therapy in the first 8 months.
Assuntos
Injúria Renal Aguda , Neoplasias Hematológicas , Leucemia Linfocítica Crônica de Células B , Injúria Renal Aguda/etiologia , Idoso , Biópsia , Fadiga , Feminino , HumanosRESUMO
Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes (POEMS) syndrome is a rare disease, and only in a minority of cases, causes an impairment of kidney function. Here, we describe a case of a 55-year-old man with a history of POEMS syndrome who presented with acute kidney injury following a routine blood test. On further investigation, a relapse in POEMS syndrome was diagnosed, uniquely isolated to renal involvement.
Assuntos
Injúria Renal Aguda/etiologia , Síndrome POEMS/complicações , Injúria Renal Aguda/fisiopatologia , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Síndrome POEMS/fisiopatologia , RecidivaRESUMO
Granulomatosis with polyangiitis (GPA) causing liver injury is rare. Where liver biopsies have been taken findings are not always typical and diagnosis can be challenging. Here, we present a case of a 58-year-old male who on admission to hospital was found to have acute liver injury. Diagnosis of liver involvement in GPA is supported by liver histology and the resolution of hepatitis after commencement of immunosuppressive treatment.
Assuntos
Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/patologia , Hepatopatias/tratamento farmacológico , Hepatopatias/patologia , Fígado/lesões , Doença Aguda/epidemiologia , Granulomatose com Poliangiite/diagnóstico , Humanos , Fatores Imunológicos/uso terapêutico , Fígado/patologia , Hepatopatias/etiologia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Rituximab/administração & dosagem , Rituximab/uso terapêutico , Resultado do TratamentoRESUMO
Thyroid carcinoma presenting as a hyperfunctioning thyroid nodule is rare. A further complexity is added when interpretation of the histopathology itself is not straightforward. We describe a case of a 16-year-old girl presenting with clinical and biochemical evidence of thyrotoxicosis, and a 4â cm thyroid mass. An ultrasound and thyroid uptake scan demonstrated a toxic adenoma. Owing to the nodule size, fine needle aspiration of the thyroid adenoma was performed, which showed findings consistent with toxic adenoma. However, in view of the size of the nodule, a hemithyroidectomy was performed. Histological examination of the thyroid revealed a follicular variant of papillary carcinoma of the thyroid, and the patient underwent completion thyroidectomy. We report on the case and briefly review the available literature relating to the diagnostic challenge of this presentation.
Assuntos
Carcinoma/diagnóstico , Carcinoma/cirurgia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adolescente , Biópsia por Agulha Fina , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma Papilar , Diagnóstico Diferencial , Feminino , Humanos , Radiografia , Câncer Papilífero da Tireoide , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Tireotoxicose/diagnósticoRESUMO
Lymphoma presenting as a parotid gland tumour without systemic involvement is rare, especially with respect to a non-Hodgkin's lymphoma. Furthermore, when such cases present there is often a low degree of clinical suspicion as there may be few clinical features to suggest the diagnosis. We describe an unexpected case that presented during an acute medical intake. The case was an 84-year-old man presenting acutely unwell with an ulcerating mass over the right side of the face, septicaemia and acute kidney injury. Following aggressive initial management the patient improved. Later cytological examination of a fine needle aspiration from the mass confirmed a B-cell non-Hodgkin's lymphoma. He had no evidence of other systemic involvement or of B-symptoms. We report on the case and briefly review the available literature relating to the prevalence of non-Hodgkin's lymphoma of the parotid gland.