An inconspicuous insect bite as the cause of sepsis in a patient treated with infliximab due to rheumatoid arthritis.

The monoclonal antibody against TNFa (infliximab) suppresses cytokines involved in inflammatory reaction. Consequently, infliximab is a potent agent in treating refractory rheumatoid arthritis (RA). There is also evidence showing beneficial anti-TNFα therapy effect on RA-related amyloidosis AA. TNFα inhibition may, however, lead to leucopenia and, eventually, severe sepsis. We discuss a case of RA with RA-related AA amyloidosis and renal impairment which was refractory to disease-modifying anti-rheumatic drug (DMARD). The treatment led to inflammatory complications of two distinct phases: immediately after drug administration and six weeks later. Both phases were linked to an innocuous skin infection.

[Lupus pregnancy, its effect on the course of lupus nephritis and the evaluation of fetal loss frequency]. / Ciaza u chorych na toczen ukladowy, wplyw na przebieg toczniowego zapalenia nerek, ocena niepowodzen polozniczych.

The subject of analysis were data concerning the 101 pregnancies in 43 patients with systemic lupus erythematodes observed in years 1965-1990. The evaluation proved that pregnancy does not deteriorate the course of lupus nephritis that is in the remission before the conception. In lupus patients the risk of fetal loss and stillbirth is high, especially in the presence of anticardiolipin antibodies. The course of active lupus occurring during pregnancy is frequently severe and its effect on the pregnancy is very harmful.

[Monthly intravenous cyclophosphamide in the treatment of lupus nephritis]. / Comiesieczne dozylne wlewy cyklofosfamidu w leczeniu toczniowego zapalenia nerek.

21 patients with severe active lupus nephritis (LN) were treated with intravenous cyclophosphamide monthly doses 0.75 g/m2. The effects were compared with the results obtained in 22 patients by the oral prednisone administration in the dose 1 mg/kg/day. Both groups were not significantly different as regards the initial intensity of the LN symptoms. Complete or partial remission occurred in 17 patients (80.9%) receiving intravenous cyclophosphamide. End-stage renal failure in 2 patients and moderate renal insufficiency in other 2 patients from that group. In the prednisone treated group complete or partial remission was observed in 13 subjects (59.1%). The significant deterioration of the renal function occurred in 9 patients, in 6 into the phase of a moderate renal insufficiency and in 3 patients to the end-stage kidney failure. Additionally, the significant increase of the total serum complement activity and of the plasma platelets count was observed in the cyclophosphamide group, whereas those indicators did not improve in the patients receiving prednisone. The of intravenous pulse cyclophosphamide exhibits an advantage in the treatment of severe proliferative LN.

Hereditary porphyria manifesting itself during renal failure in a 49-year-old woman.

Clinical findings in a female patient aged 49 years suggested Conn's syndrome (hypokalemia, alkalosis, hypertension) developing in the course of renal failure. During treatment biochemically confirmed porphyria manifested itself, and the patient died several days later. On autopsy and in histological examinations malignant nephrosclerosis of vascular origin, nodular hyperplasia of the adrenal cortex and lesions of other organs were found. The largest content of porphyrins was shown in the adrenals, and then in the liver, pituitary gland, thyroid and pancreas. A study of other family members confirmed the genetic background of porphyria. Probably, this hereditary latent hepatic porphyria manifested itself after a breakdown of the feedback mechanisms between the kidneys and the endocrine glands, the adrenals in particular.