A case of Graves’ disease associated with membranoproliferative glomerulonephritis and leukocytoclastic vasculitis

2018 ◽  
Vol 31 (10) ◽  
pp. 1165-1168 ◽  
Author(s):  
Werner Keenswijk ◽  
Eva Degraeuwe ◽  
Anne Hoorens ◽  
Jo Van Dorpe ◽  
Johan Vande Walle
Keyword(s):  
Renal Function ◽  
Membranoproliferative Glomerulonephritis ◽  
Leukocytoclastic Vasculitis ◽  
White Cell Count ◽  
Gastrointestinal Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Complement Factor ◽  
Gradual Improvement ◽  
Complement Factor C3

Abstract Background The association of hyperthyroidism with renal disease is very rare and the importance of timely clinical recognition cannot be overemphasized. Case presentation An 11-year-old girl presented with gastrointestinal symptoms while hypertension, edema and abdominal pain were noticed on clinical examination. Laboratory investigation revealed: hemoglobin 9.4 (11.5–15.5) g/dL, total white cell count 16 (4.5–12)×109/L, platelets 247 (150–450)×109/L, C-reactive protein (CRP) 31.8 (<5) mg/L, blood urea nitrogen (BUN) 126 (13–43) mg/dL, creatinine 0.98 (0.53–0.79) mg/dL, albumin 25 (35–52) g/dL, complement factor C3 0.7 (0.9–1.8) g/L, complement factor C4 0.1 (0.1–0.4) g/L, tri-iodothyronine 6.5 (2.5–5.2) pg/mL, free thyroxine 2.4 (1–1.7) ng/dL, thyroid stimulating hormone (TSH) <0.02 (0.5–4.3) mU/L. Urinalysis showed nephrotic range proteinuria. Renal function deteriorated necessitating hemodialysis (HD). A renal biopsy revealed an immune complex-mediated membranoproliferative glomerulonephritis (MPGN). Elevated thyroid hormones and suppressed TSH levels with elevated thyroperoxidase antibodies and thyroid stimulating immunoglobulins confirmed the diagnosis of Graves’ disease. Corticosteroids were commenced and eventually thiamazole was added with gradual improvement of renal function, cessation of HD and discharge from the hospital. Conclusions Graves’ disease complicated by MPGN is extremely rare, but can cause life-threatening complications.

scholarly journals Evidence for non-traditional activation of complement factor C3 during murine liver regeneration

2008 ◽  
Vol 45 (11) ◽  
pp. 3125-3132 ◽  
Author(s):  
Amelia Clark ◽  
Alexander Weymann ◽  
Eric Hartman ◽  
Yumirle Turmelle ◽  
Michael Carroll ◽  
...  
Keyword(s):  
Liver Regeneration ◽  
Complement Factor ◽  
Murine Liver ◽  
Complement Factor C3

Bromate Poisoning From Hair Permanent Preparations

PEDIATRICS ◽  
1985 ◽  
Vol 76 (6) ◽  
pp. 975-978
Author(s):  
BARRY L. WARSHAW ◽  
MELODY C. CARTER ◽  
LEONARD C. HYMES ◽  
BARBARA S. BRUNER ◽  
ALBERT P. RAUBER
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Hearing Impairment ◽  
Peritoneal Lavage ◽  
Gastrointestinal Symptoms ◽  
Potassium Bromate ◽  
Cold Wave ◽  
Toxic Substances

Potassium bromate is a tasteless, odorless, and colorless chemical found in the neutralizing solution of cold wave home hair permanents and profesional solutions. Toxic ingestions of this substance were initially reported during the 1940s and 1950s and are characterized primarily by gastrointestinal symptoms, hearing impairment, and acute renal failure.1 Although many manufacturers have now substituted less toxic substances as neutralizers, use of potassium bromate in some hair permanent solutions continues, and poisonings from this substance still occur.2-4 Because renal failure from potassium bromate intoxication may be severe, dialysis may be necessary for replacement of renal function. Moreover, a major toxicology reference presently suggests that "if readily available, the prompt use of hemodialysis or peritoneal lavage may serve to remove absorbed but unreacted bromate in significant amounts."1

scholarly journals Graves Disease in Childhood

2021 ◽  
Author(s):  
Madhukar Mittal ◽  
Vanishri Ganakumar
Keyword(s):  
Thyroid Hormone ◽  
Side Effects ◽  
Age Of Onset ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Older Children ◽  
Prepubertal Children ◽  
Pediatric Age Group

Graves’ disease (GD) is an autoimmune disease caused by autoantibodies against thyroid stimulating hormone receptor (TSH-R), resulting in stimulation of thyroid gland and overproduction of thyroid hormones resulting in clinical manifestations. It is uncommon in children and is 6 times more prevalent in females. The symptomatology, clinical and biochemical severity are a function of age of onset of disease. Prepubertal children tend to present with weight loss and bowel frequency, associated with accelerated growth and bone maturation. Older children are more likely to present with the classical symptoms of thyrotoxicosis like palpitations, tremors and heat intolerance. Prepubertal children tend to have a more severe disease, longer duration of complaints and higher thyroid hormone levels at presentation than the pubertal and postpubertal children. The non-specificity of some of the symptoms in pediatric age group can lead to children being initially seen by other specialities before being referred to endocrinology. Management issues are decided based on patient’s priorities and shared decision making between patient and treating physician. Radioactive Iodine Ablation is preferred when there is relatively higher value placed on Definitive control of hyperthyroidism, Avoidance of surgery, and potential side effects of ATDs. Similarly Antithyroid drugs are chosen when a relatively higher value is placed on possibility of remission and avoidance of lifelong thyroid hormone treatment, Avoidance of surgery, Avoidance of exposure to radioactivity. Surgery is preferred when access to a high-volume thyroid surgeon is available and a relatively higher value is on prompt and definitive control of hyperthyroidism, avoidance of exposure to radioactivity and avoidance of potential side effects of ATDs. Continental differences with regards to management do exist; radio-iodine ablation being preferred in North America while Anti-thyroid drug treatment remains the initial standard care in Europe.

scholarly journals Results obtained after the surgical treatment of Graves’ disease depending on the levels of anti-thyroid antibodies

2021 ◽  
Author(s):  
S. L. Shliakhtych ◽  
V. R. Antoniv
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Technique ◽  
Hormone Receptors ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Surgery ◽  
Graves Disease ◽  
Autoimmune Thyroid ◽  
Early Postoperative Complications ◽  
Surgery Duration

Graves' disease (GD) is a hereditary autoimmune disease which is characterized by persistent abnormal hypersecretion of thyroid hormones and thyrotoxicosis syndrome development. GD affects from 0.5 % to 2.0 % of population in different regions. 46 % of these patients develop ophthalmopathy. GD is a common cause of disabilities in patients under 60 years of age. In recent years, the incidence of GD in Ukraine has increased by 9.9 % — from 106.2 to 117.9 per 100,000 individuals. This can be connected with the improved diagnostic possibilities and active disease detection as well as with the increased number of autoimmune thyroid disorders. The recent studies focus on prevention of specific complications and recurrences of GD after surgery. Objective — to compare the levels of antibodies to the thyroid‑stimulating hormone receptors (TSHR‑Ab) during different postoperative periods as well as the incidence of early and late complications depending on the surgical technique used for the treatment of GD. Materials and methods. The results of surgical treatment of 130 patients, with GD were compared. 29 male patients and 101 female patients aged from 19 to 76 (average — 44.1 ± 3.2 years), receiving their treatment for GD in Kyiv Center of Endocrine Surgery during 2010—2018, were randomly selected and divided into two groups. At the time of operation the duration of disease was from 1 to 30 years (average — 4.6 ± 1.2 years). Group  1 included 65 patients that underwent total thyreoidectomy (TT) and group 2 included 65 patients that underwent subtotal thyreoidectomy (ST). The following parameters were compared: surgery duration, the incidence of early postoperative complications, including bleedings and damage to the recurrent laryngeal nerves, and late outcomes of surgical treatment (persistent hypoparathyreoidism disorder and disorder recurrences) depending on the method of surgery (ST or TT). Furthermore, the patterns of the TSHR‑Ab level reduction were studied for different postoperative periods. Results. The comparison of surgical outcomes following TТ and ST didn’t reveal any statistically significant differences in such evaluation criteria as the average surgery duration, the average volume of intraoperative blood loss and the average duration of the postoperative inpatient treatment. The comparative assessment of the thyroid stump volume and the average amount of drained discharge showed statistically significant differences for TТ. It allows considering TТ as a surgery which causes less complications than ST. The studied parameters of early postoperative complications had no significant differences for ST and TТ. The long‑term (5 years) postoperative level of TSHR‑Ab was statistically significantly lower in patients after TT and made up 1.15 ± 0.13 IU/L (thus corresponding to the normal level). Conclusions. Total thyroidectomy is an optimal surgical technique and is more appropriate compared with subtotal thyroid gland resection. It should be noted that TT provides lower risk of complications due to significantly lower level of TSHR‑Ab in late postoperative period.  

scholarly journals Discrete viral E2 lysine residues and scavenger receptor MARCO are required for clearance of circulating alphaviruses

eLife ◽  
2019 ◽  
Vol 8 ◽  
Author(s):  
Kathryn S Carpentier ◽  
Bennett J Davenport ◽  
Kelsey C Haist ◽  
Mary K McCarthy ◽  
Nicholas A May ◽  
...  
Keyword(s):  
Disease Severity ◽  
Mutational Analysis ◽  
Scavenger Receptor ◽  
Transmission Efficiency ◽  
Complement Factor ◽  
Critical Determinant ◽  
Lysine Residues ◽  
Complement Factor C3 ◽  
Immune Pathway ◽  
Innate Immune Pathway

The magnitude and duration of vertebrate viremia is a critical determinant of arbovirus transmission, geographic spread, and disease severity. We find that multiple alphaviruses, including chikungunya (CHIKV), Ross River (RRV), and o’nyong ‘nyong (ONNV) viruses, are cleared from the circulation of mice by liver Kupffer cells, impeding viral dissemination. Clearance from the circulation was independent of natural antibodies or complement factor C3, and instead relied on scavenger receptor SR-A6 (MARCO). Remarkably, lysine to arginine substitutions at distinct residues within the E2 glycoproteins of CHIKV and ONNV (E2 K200R) as well as RRV (E2 K251R) allowed for escape from clearance and enhanced viremia and dissemination. Mutational analysis revealed that viral clearance from the circulation is strictly dependent on the presence of lysine at these positions. These findings reveal a previously unrecognized innate immune pathway that controls alphavirus viremia and dissemination in vertebrate hosts, ultimately influencing disease severity and likely transmission efficiency.

scholarly journals A norovirus outbreak triggered by copper intoxication on a coach trip from the Netherlands to Germany, April 2010

2012 ◽  
Vol 17 (9) ◽  
Author(s):  
J Hoefnagel ◽  
D H van de Weerdt ◽  
O Schaefer ◽  
R Koene
Keyword(s):  
Renal Function ◽  
Chemical Analysis ◽  
Liver Function ◽  
Gastrointestinal Symptoms ◽  
Copper Level ◽  
Epidemic Curve ◽  
Potential Source ◽  
Toxic Concentration ◽  
Stool Samples ◽  
Copper Intoxication

We report an unusual outbreak of norovirus infection on a coach trip. Overall, 30 of 40 people (including drivers and crew) developed nausea, vomiting and/or diarrhoea, 11 of them on the first day of the trip. The incidence epidemic curve showed a first peak on Day 1 and a second on Day 4. Nine passengers were hospitalised with gastrointestinal symptoms. Norovirus was found in stool samples from two patients, but the infection could not explain the first peak in the epidemic curve only a few hours after departure. Interviews with the passengers and an inspection of the coach and its water supply implicated the water used for coffee and tea as the potential source. Microbiological investigations of the water were negative, but chemical analysis showed a toxic concentration of copper. Blood copper levels as well as renal and liver function were determined in 28 of the 32 passengers who had been exposed to the water. One passenger who did not have gastrointestinal symptoms had an elevated copper level of 25.9 µmol/L, without loss of liver or renal function. It is likely that the spread of norovirus was enhanced because of vomiting of one of the passengers due to copper intoxication.

scholarly journals Fine mapping MHC associations in Graves’ disease and its clinical subtypes in Han Chinese

2018 ◽  
Vol 55 (10) ◽  
pp. 685-692 ◽  
Author(s):  
Xun Chu ◽  
Minjun Yang ◽  
Zhen-Ju Song ◽  
Yan Dong ◽  
Chong Li ◽  
...  
Keyword(s):  
Amino Acid ◽  
Molecular Mechanisms ◽  
Amino Acid Level ◽  
Antithyroid Drug ◽  
Amino Acid Position ◽  
Thyroid Stimulating Hormone ◽  
Han Chinese ◽  
Graves Disease ◽  
Hla Genes ◽  
Antithyroid Drug Therapy

BackgroundThe classical human leucocyte antigen (HLA) genes were the most important genetic determinant for Graves’ disease (GD). The aim of the study was to fine map causal variants of the HLA genes.MethodsWe applied imputation with a Pan-Asian HLA reference panel to thoroughly investigate themajor histocompatibility complex (MHC) associations with GD down to the amino acid level of classical HLA genes in 1468 patients with GD and 1490 controls of Han Chinese.ResultsThe strongest finding across the HLA genes was the association with HLA-DPβ1 position 205 (Pomnibus=2.48×10−33). HLA-DPA1*02:02 was the strongest association among the classical HLA alleles, which was in perfect linkage disequilibrium with HLA-DPα1 residue Met11 (OR=1.90, Pbinary=1.76×10−31). Applying stepwise conditional analysis, we identified amino acid position 205 in HLA-DPβ1, position 66 and 99 in HLA-B and position 28 in HLA-DRβ1 explain majority of the MHC association to GD risk. We further evaluated risk of two clinical subtypes of GD, namely persistent thyroid stimulating hormone receptor antibody -positive (pTRAb+) group and ‘non-persistent TRAb positive’ (pTRAb−) group after antithyroid drug therapy. We found that HLA-B residues Lys66-Arg69-Val76 could drive pTRAb− GD risk alone, while HLA-DPβ1 position 205, HLA-B position 69 and 199 and HLA-DRβ1 position 28 drive pTRAb+ GD risk. The risk heterogeneity between pTRAb+ and pTRAb− GD might be driven by HLA-DPα1 Met11.ConclusionsFour amino acid positions could account for the associations of MHC with GD in Han Chinese. These distinct HLA association patterns indicated the two subtypes have distinct molecular mechanisms of pathogenesis.

Clinical characteristics and genetic analysis of 3 A20 Haploinsufficiency patients

2021 ◽  
Author(s):  
Dan Zhang ◽  
Zhixuan Zhou ◽  
Jianming Lai ◽  
Gaixiu Su
Keyword(s):  
Genetic Testing ◽  
Age Of Onset ◽  
Immunosuppressive Agents ◽  
Disease Patient ◽  
Gastrointestinal Symptoms ◽  
Coombs Test ◽  
Gradual Improvement ◽  
Genetic Characteristics ◽  
Tnfaip3 Gene ◽  
Oral Ulcers

Abstract Backguound To evaluate the clinical and genetic characteristics of 3 children with HA20. Methods The clinical and genetic testing data of 3 children with HA20 treated at CIP between August 2016 and October 2019 were retrospectively analysed. Results Patient 1 presented with arthritis and inflammatory bowel disease, patient 2 presented with axial spinal arthritis and lupus-like syndrome, and patient 3 presented with recurrent oral ulcers, gastrointestinal ulcers, and perianal abscesses. For laboratory examination, In patient 1, the WBC,CRP and AESR showed high. In patient 2, the WBC was normal, but CRP and AESR showed high. In patient 3, the WBC, CRP, and AESR showed high. Patient 2 was positive for antinuclear antibodies, anti-Sjögren’s syndrome antigen A, dsDNA, rheumatoid factor and Coombs test. Genetic testing showed that the 3 patients were heterozygous for mutations in the TNFAIP3 gene. For treatment, patient 1 used TNFα antagonist and thalidomide, patient 2 used TNFαantagonist and sulfasalazine, and patient 3 used hormones and thalidomide. Patients 1 and 2 were followed up for 4 and 3 months, respectively. There was improvement in joint and gastrointestinal symptoms, inflammatory indices and RF were normal, dsDNA and Coombs test became negative. Patient 3 was treated at an outside hospital and showed gradual improvement in oral ulcers and perianal abscesses. Conclusion HA20 is a single-gene auto-inflammatory disease caused by mutation in the TNFAIP3 gene. It presents clinically as a Behçet-like syndrome and can present as various other autoimmune diseases as well. Hormones and immunosuppressive agents are effective treatments, and cytokine antagonists can be used in refractory cases. Whole-exome genetic testing should be proactively performed for children with an early age of onset or Behçet-like presentation to achieve early diagnosis and accurate treatment.

Henoch-Schoenlein Purpura

1992 ◽  
Vol 13 (4) ◽  
pp. 130-137
Author(s):  
Shelley Lanzkowsky ◽  
Leora Lanzkowsky ◽  
Philip Lanzkowsky
Keyword(s):  
Abdominal Pain ◽  
Leukocytoclastic Vasculitis ◽  
Renal Involvement ◽  
Gastrointestinal Symptoms ◽  
Female Ratio ◽  
Course Of Illness ◽  
Colicky Abdominal Pain ◽  
Allergic Vasculitis ◽  
Male To Female ◽  
First Descriptions

The distinctive syndrome of Henoch-Schoenlein purpura (HSP) was first described by Heberden before 1800, and in 1808 English physician Robert Willan described a patient who had swollen, painful joints and a rash. The syndrome owes its name to two German physicians. In 1837, Johan Schoenlein described several cases of purpura associated with arthritis, which he termed "peliosis rheumatica." In 1868, Edouard Henoch pointed out that the term "peliosis rheumatica" was inappropriate and restrictive because patients who had urticarial purpura and acute arthritis also manifested gastrointestinal symptoms, such as vomiting, colicky abdominal pain, and melena. He described four children who had purpura, colicky abdominal pain, gastrointestinal hemorrhage, and joint pain as well as renal involvement.1 Since these first descriptions, HSP also has been referred to as anaphylactoid, allergic, or rheumatoid purpura; leukocytoclastic vasculitis; and allergic vasculitis.1,2 Epidemiology Seventy-five percent of all cases of HSP occur in children between 2 and 11 years of age, with younger children rarely affected. Children younger than 2 y experience a milder course of illness, with less frequent renal and gastrointestinal manifestations.3 HSP is exceedingly rare in adults, among whom other causes of vasculitis should be considered more likely. The incidence of HSP is greater in males, with a male-to-female ratio of 1.5 to 2.0:1.

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