Collapsing Focal Segmental Glomerulosclerosis in a Patient with Acute Malaria

Introduction. Collapsing focal segmental glomerulosclerosis (FSGS) is most commonly seen in association with HIV infection. Rare data is available about the association between collapsing FSGS and malaria.Case Description. A 72-year-old African male patient presented to the hospital for generalized body aches, fatigue, fever, and night sweats for three days. He had history of recent travel to Ghana. Patient looked in acute distress and was shivering. Laboratory tests showed elevated serum creatinine (Cr) of 2.09 mg/dL (baseline was 1.5 mg/dL in 2012). Hospital course was significant for rapid elevation of Cr to 9.5 mg/dL and proteinuria of 7.9 grams. Autoimmune studies resulted negative. Blood smear resulted positive forPlasmodium falciparumand patient was treated with Artemether/Lumefantrine. Patient’s fever and pain improved, but kidney function continued to deteriorate and he became oliguric. On day seven, he was started on Hemodialysis. Tests for different causes of glomerular pathology were also negative. He underwent left kidney biopsy which resulted in findings consistent with severe collapsing glomerulopathy.Discussion. This case illustrates a biopsy proven collapsing FSGS likely secondary to malarial infection requiring renal replacement therapy. Literature review revealed only few case reports that suggested the possible association of malaria with secondary form of FSGS.

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Collapsing focal segmental glomerulosclerosis probably triggered by dengue virus infection - two case reports

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0237 ◽

2020 ◽

Author(s):

Patrícia Cruz Queiroz ◽

Ana Elisa Souza Jorge ◽

Plínio Henrique Vaz Mourão ◽

Maria Goretti Moreira Guimarães Penido

Keyword(s):

Renal Function ◽

Nephrotic Syndrome ◽

Virus Infection ◽

Dengue Virus ◽

Focal Segmental Glomerulosclerosis ◽

Case Reports ◽

Kidney Injury ◽

Dengue Virus Infection ◽

Segmental Glomerulosclerosis ◽

Collapsing Fsgs

Abstract The reported cases describe the association between collapsing focal segmental glomerulosclerosis (FSGS) and acute dengue virus infection. In both cases, patients were diagnosed with dengue virus infection and had a severe kidney disease, with nephrotic syndrome and acute kidney injury. Kidney biopsy was performed and showed collapsing FSGS. The first patient, a 27-year-old man, was diagnosed with dengue virus infection and developed nephrotic syndrome after two weeks of illness. He was treated with methylprednisolone for three days and intravenous furosemide. This patient evolved well, although his renal function did not fully recover. The second patient, a 32-year-old man, was diagnosed with a milder clinical presentation of dengue virus infection. He had a past medical history of nephrotic syndrome in childhood, which might have caused its relapse. This patient was treated with intravenous furosemide and also did not fully recover renal function. These cases highlight the possible implication of dengue virus infection in the etiology of collapsing variant of FSGS. Healthcare professionals should be prepared to identify similar cases.

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Case Report: Collapsing Focal Segmental Glomerulosclerosis After Initiation of Ado-Trastuzumab Emtansine Therapy

Frontiers in Oncology ◽

10.3389/fonc.2021.796223 ◽

2021 ◽

Vol 11 ◽

Author(s):

Samy Hakroush ◽

Svenja Wulf ◽

Julia Gallwas ◽

Björn Tampe

Keyword(s):

Focal Segmental Glomerulosclerosis ◽

Kidney Biopsy ◽

Case Reports ◽

Adverse Event Reporting System ◽

Specific Treatment ◽

Trastuzumab Emtansine ◽

Antibody Drug Conjugate ◽

Segmental Glomerulosclerosis ◽

Collapsing Fsgs ◽

Nephrotic Range Proteinuria

Ado-trastuzumab emtansine (T-DM1) is an antibody–drug conjugate consisting of the monoclonal antibody trastuzumab linked to the maytansinoid DM1 with potential antineoplastic activity and is approved for human epidermal growth factor receptor 2 (HER2)-positive breast cancer. An analysis of the US Food and Drug Administration (FDA) Adverse Event Reporting System identified 124/1,243 (10%) renal adverse events for trastuzumab. However, there are no published case reports describing kidney biopsy findings related to nephrotoxicity of either trastuzumab or T-DM1. We report kidney biopsy findings in a case of nephrotic range proteinuria due to collapsing focal segmental glomerulosclerosis (FSGS) and tubular injury after initiation of T-DM1 therapy. After systematic exclusion of other causes, it is likely that the observed collapsing FSGS was associated with the prior initiation of T-DM1 therapy. This is further supported by the clinical course with improvement of proteinuria and kidney function 3 weeks after discontinuation of T-DM1 therapy without further specific treatment. In summary, we provide the first report of kidney biopsy findings in a case of nephrotic range proteinuria after initiation of T-DM1 therapy due to collapsing FSGS. This issue is especially relevant since T-DM1 is widely used, and nephrologists have to be aware of this potentially rare but severe complication.

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Interesting case of dual pathology: Crohn’s disease and Peutz-Jeghers syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-234513 ◽

2020 ◽

Vol 13 (10) ◽

pp. e234513

Author(s):

Mantej Sehmbhi ◽

Penelope Sellers ◽

Jonathan Segal ◽

Susan Clark

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Interesting Case ◽

Night Sweats ◽

History Of ◽

Progressive Weight Loss ◽

Inflammatory Bowel ◽

Peutz Jeghers Syndrome ◽

The Uk

An 18-year-old man presented with fever, night sweats and progressive weight loss over 2 months. He had a history of Peutz-Jeghers syndrome (PJS) complicated by previous intussusception requiring left hemicolectomy. Colonoscopy revealed deep punched out ulceration throughout the colon with multiple polyps. He was investigated for tuberculosis based on his occupation as dairy farmer. Following a negative QuantiFERON test, he was started on infliximab as emergency therapy and made a good recovery at 6 months follow-up. We describe a case of newly diagnosed Crohn’s disease (CD) in an adolescent with a background diagnosis of PJS. While inflammatory bowel disease, such as CD, is common in the UK, the association with PJS is very rare, with only two existing case reports in the literature.

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Sudden Cardiac Arrest during Adenotonsillectomy in a Patient with Subclinical Duchenne's Muscular Dystrophy

Ear Nose & Throat Journal ◽

10.1177/014556139307200206 ◽

1993 ◽

Vol 72 (2) ◽

pp. 130-131 ◽

Cited By ~ 8

Author(s):

Nick C. Benton ◽

Robert A. Wolgat

Keyword(s):

Cardiac Arrest ◽

Muscular Dystrophy ◽

General Anesthesia ◽

Case Reports ◽

Sudden Cardiac Arrest ◽

Elevated Serum ◽

Serum Creatine Kinase ◽

Strong Family History ◽

History Of ◽

Duchenne's Muscular Dystrophy

We describe a four-year-old boy of Indian descent who had elective adenotonsillectomy for chronic sore throat and partial airway obstruction. About 10 minutes into the procedure, the patient suddenly developed cardiac asystole. After prolonged cardiac resuscitation, recovery was achieved. No permanent neurologic deficits resulted. The child was later found to have a strong family history of Duchenne's muscular dystrophy (DMD) and an elevated serum creatine kinase level documented since shortly after birth. We reviewed several case reports substantiating the risk for cardiac arrest during general anesthesia in DMD patients, and we concluded that DMD is a little-known risk for cardiac arrest during general anesthesia. The otolaryngologist must be aware of this potential complication, because tonsillectomy and adenoidectomy are commonly indicated for children at an age when DMD may be subclinical.

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Apheresis treatment of recurrent focal segmental glomerulosclerosis after kidney transplantation: Re-analysis of published case-reports and case-series

Journal of Clinical Apheresis ◽

10.1002/jca.10007 ◽

2001 ◽

Vol 16 (4) ◽

pp. 175-178 ◽

Cited By ~ 37

Author(s):

Robertson D. Davenport

Keyword(s):

Kidney Transplantation ◽

Focal Segmental Glomerulosclerosis ◽

Case Reports ◽

Case Series ◽

Segmental Glomerulosclerosis

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Metanephric Adenoma with Embryonal Hyperplasia of Bowman's Capsular Epithelium: Previously Unreported Association

Pediatric and Developmental Pathology ◽

10.1007/s100240010093 ◽

2000 ◽

Vol 3 (5) ◽

pp. 472-478 ◽

Cited By ~ 10

Author(s):

Keshani de Silva ◽

Vivienne Tobias ◽

Gad Kainer ◽

Bruce Beckwith

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

Chronic Renal Failure ◽

Focal Segmental Glomerulosclerosis ◽

Left Kidney ◽

Bilateral Nephrectomy ◽

Metanephric Adenoma ◽

Histological Features ◽

Segmental Glomerulosclerosis

We report a case of a 9-year-old boy with focal, segmental glomerulosclerosis who, following peritoneal dialysis, underwent renal transplantation and bilateral nephrectomy. The kidneys showed histological features of embryonal hyperplasia of Bowman's capsular epithelium, an uncommon lesion that is seen most often in patients with chronic renal failure who are being maintained on dialysis. In addition, a 1-cm tumor in the left kidney showed features of metanephric adenoma. Although both lesions are uncommon, they share many similarities on a morphological, immunohistochemical, and ultrastructural basis. This association has not been previously reported and may shed some light on the histogenesis of these recently described lesions.

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SAT-LB87 Golimumab Induced Thyroiditis

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2314 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Mo M Mai ◽

Jocelyne G Karam ◽

Nyein Lynn ◽

Gurbaj Singh ◽

Elizabeth Sedlis Singer

Keyword(s):

Thyroid Nodules ◽

Case Reports ◽

Elevated Serum ◽

Subacute Thyroiditis ◽

Abnormal Behavior ◽

Weight Changes ◽

Drug Induced ◽

Thyroid Cells ◽

Patient Reported ◽

History Of

Abstract Background: Subacute thyroiditis is caused by an inflammation and a destruction of the thyroid cells, leading to hyperthyroidism due to leakage of thyroid hormones, followed by possible hypothyroidism and/or full recovery of thyroid function. This is a case report describing a rare occurrence of drug-induced thyroiditis secondary to golimumab. Clinical Case: A 79-year-old female with HTN, hyperlipidemia, dementia and rheumatoid arthritis was brought to the ER for abnormal behavior including visual hallucinating and insomnia.Initial ER evaluation showed UTI for which antibiotic therapy was initiated. Dementia workup was performed including a negative head CT, nonreactive RPR, and borderline low vitamin B12 level. TFT obtained showed low TSH of 0.2mlU/L, elevated serum FT4 of 1.72ng/ml (n=0.58-1.64ng/ml) and elevated serum FT3 4.38pg/ml (n=2.5-3.9pg/ml), suggestive of hyperthyroidism. The patient reported no heat intolerance, hyperdefecation, or weight changes, but had intermittent palpitations. She denied any history of thyroid problem and did not take thyroid medication, amiodarone, biotin, or any new drug. She reported no fever or URI symptoms within the few weeks prior to admission. In addition to prednisone and methotrexate, she was taking golimumab 50mg every 30 days for the last 22 months for RA. The patient had a family history of hypothyroidism of two daughters and sister. She denied smoking, alcohol, or any other recreational drug use. Her home medications included prednisone 5mg daily, methotrexate, folic acid, lisinopril, simvastatin, and golimumab. On physical examination, she did not appear thyrotoxic and had no exophthalmos, thyroid tenderness, thyroid enlargement or thyroid nodules. Her HR range was 80bpm.Further analysis revealed normal TSI, TPO, and TgAb levels. The thyroglobulin level was very high at 2505ng/ml (n=1.6-59.9ng/ml). Her thyroid sonogram revealed bilateral thyroid nodules, largest at 1.9cm in the right mid pole. A 24-hr RAIU scan showed very low uptake (1.8%) consistent with thyroiditis (hyperthyroid phase).Endocrinology team did not recommend any antithyroid medications. In addition, she did not warrant NSAIDs or beta blockers as she was not symptomatic or tachycardic. In the absence of an autoimmune or an obvious viral process, her subacute thyroiditis was thought to be induced by golimumab. Conclusion: TNFɑ inhibitors used to treat chronic inflammatory diseases, have been rarely associated with subacute thyroiditis as described in case reports with adalimumab and etanercept use. We report the first subacute thyroiditis associated with golimumab use. We suggest that drug-induced subacute thyroiditis should be one of the differential diagnoses of thyroid dysfunction in patients treated with golimumab.

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Successful use of carbamazepine in a patient with drug rash with eosinophilia and systemic symptoms

Mental Health Clinician ◽

10.9740/mhc.2019.09.331 ◽

2019 ◽

Vol 9 (5) ◽

pp. 331-335

Author(s):

Alexandra L. Bixby ◽

Sarah Goldsborough ◽

Aaron Iuppa ◽

Andrew LeBlanc ◽

Heather E. Schultz ◽

...

Keyword(s):

Case Reports ◽

Elevated Serum ◽

Primary Treatment ◽

Cross Reactivity ◽

Pathology Report ◽

Medline Search ◽

History Of ◽

Drug Rash ◽

Elevated Creatinine ◽

Systemic Symptoms

Abstract Drug rash with eosinophilia and systemic symptoms (DRESS) is a serious adverse drug reaction with a high mortality rate. Discontinuation of the causative agent is the primary treatment. History of DRESS may put patients at higher risk of future episodes; however, cross-reactivity between various medications is not well established. An 18-year-old African American male with a history of bipolar I disorder with psychotic features was admitted for mania on his home dose of divalproex. After 1 week, olanzapine was added for refractory symptoms, but due to elevated creatinine phosphokinase (CPK), it was subsequently discontinued, and he was started on lorazepam and lithium. One week later, the patient was transferred to the intensive care unit with elevated CPK, fever, thrombocytopenia, elevated serum creatinine, hypotension, diarrhea, mild rigidity, bilateral inducible ankle clonus, and a rash. All medications were discontinued except for lorazepam. The skin pathology report was consistent with a drug eruption, and he was started on prednisone. Given continued symptoms of mania, carbamazepine was initiated. After clinical and laboratory improvement, the patient was discharged on hospital day 59 with instructions to continue carbamazepine and lorazepam. A MEDLINE search revealed no published case reports of the successful use of carbamazepine in a patient with a history of DRESS. Information regarding cross-reactivity between medications is limited primarily to aromatic antiepileptics. In our case report, carbamazepine was successfully used in a patient with a recent episode of DRESS during olanzapine, lithium, and valproate use.

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Primary focal segmental glomerulosclerosis

10.1093/med/9780199592548.003.0057_update_001 ◽

2018 ◽

Author(s):

Alain Meyrier ◽

Patrick Niaudet

Keyword(s):

Focal Segmental Glomerulosclerosis ◽

Viral Infections ◽

Therapy Response ◽

High Dose ◽

African Origin ◽

Donor Kidney ◽

Progressive Loss ◽

Segmental Glomerulosclerosis ◽

Collapsing Fsgs ◽

Focal Segmental Sclerosis

Primary focal segmental glomerulosclerosis (FSGS) causes nephrotic syndrome and by definition is not caused by any of the known causes of podocyte toxicity or focal segmental sclerosis such as viral infections or toxins. A number of genetic causes of FSGS are commonly diagnosed in early childhood. Other causes of segmental scarring need to be distinguished. Genotypes in APOL1 of African origin are associated with higher incidence of FSGS and poorer responses to treatment. Cellular and collapsing FSGS are variants of FSGS in which there is overt acute podocytopathy and they have a relatively poor prognosis. A glomerular tip lesion is thought to have a slightly better prognosis than other types. Some cases of primary FSGS respond to high-dose corticosteroids, sometimes only after prolonged therapy. Response to steroids is a good prognostic sign, and without a response, progressive loss of renal function is likely. A circulating factor is implicated by the observation that proteinuria can recur in a donor kidney within hours of transplant. Plasma exchange appears to remove this factor but it is not conclusively identified.

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