Adult onset Still's disease and collapsing glomerulopathy: successful treatment with intravenous immunoglobulins and mycophenolate mofetil
| Autor: | David D'Cruz, Alexander N. Bennett, R. Hangartner, G. R. V. Hughes, Shirish Sangle, P Peterson, I C Abbs |
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| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.medical_specialty Still Disease Gastroenterology Pericardial effusion Diagnosis Differential Pericarditis Rheumatology Internal medicine medicine Humans Lupus Erythematosus Systemic Pharmacology (medical) Proteinuria medicine.diagnostic_test business.industry Immunoglobulins Intravenous Acute Kidney Injury Mycophenolic Acid medicine.disease Rash Combined Modality Therapy Surgery Renal biopsy Tamponade medicine.symptom Differential diagnosis business Still's Disease Adult-Onset Immunosuppressive Agents Follow-Up Studies |
| Zdroj: | Rheumatology (Oxford, England). 43(6) |
| ISSN: | 1462-0324 |
| Popis: | In this Grand Round we present a 32-yr-old African man who became severely ill after a 5-month history of weight loss, pyrexia, arthralgia, sweats and rash. He went on to develop pericarditis, pericardial effusion with tamponade, hepatomegaly with abnormal liver function tests, lymphadenopathy, massive proteinuria and required ventilatory, circulatory and renal support. The differential diagnosis was adult onset Still's disease, systemic lupus erythematosus (SLE), infection and lymphoma. Primary infection and lymphoma were excluded and he was treated, with dramatic success, with intravenous immunoglobulins (i.v.IG). Subsequent renal biopsy excluded SLE but confirmed collapsing glomerulopathy. The proteinuria improved dramatically following treatment with mycophenolate mofetil. We discuss some of the difficult diagnostic and management issues raised by this patient and the different uses and mechanisms of action of i.v.IG. |
| Databáze: | OpenAIRE |
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