Diabetes insipidus presentation before renal and pulmonary features in a patient with Wegener’s granulomatosis
| Autor: | Arzu Ensari, Murat Duman, Sevim Güllü, Alptekin Gursoy, Özlem Özdemir Kumbasar, Nurşen Düzgün, Yonca Morris |
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| Rok vydání: | 2005 |
| Předmět: |
Pathology
medicine.medical_specialty Immunology urologic and male genital diseases Asymptomatic Antibodies Antineutrophil Cytoplasmic Diagnosis Differential Glomerulonephritis Pituitary Gland Posterior Rheumatology Polyuria medicine Humans Immunology and Allergy Anti-neutrophil cytoplasmic antibody medicine.diagnostic_test business.industry Granulomatosis with Polyangiitis Solitary Pulmonary Nodule Middle Aged medicine.disease Nephrogenic diabetes insipidus Magnetic Resonance Imaging Methotrexate Treatment Outcome Diabetes insipidus Prednisone Drug Therapy Combination Female Renal biopsy medicine.symptom business Polydipsia Diabetes Insipidus Kidney disease |
| Zdroj: | Rheumatology International. 26:80-82 |
| ISSN: | 1437-160X 0172-8172 |
| DOI: | 10.1007/s00296-005-0583-0 |
| Popis: | We report a case of a 47-year-old woman with Wegener's granulomatosis complicated by central diabetes insipidus. The patient had initially seronegative polyarthritis which mostly responded well to methotrexate and steroid therapy. Eight months later the patient suffered from polyuria and polydipsia. There were no abnormalities of the anterior pituitary hormones. MR images showed only loss of brightness of the posterior pituitary. Extensive evaluation of the patient revealed the presence of ANCA, in c-ANCA pattern and also PR3 positivity. Three months later findings of glomerulonephritis, as suggested by an active urine sediment and gradual proteinuria, and, finally, asymptomatic pulmonary nodules completed the clinical picture of Wegener's disease within 1 year. Renal biopsy showed crescent formation in two glomeruli, consistent with ANCA-related glomerulonephritis which showed pauci-immün depositions by direct immunofluorescence. Diabetes insipidus symptoms mostly regressed; renal and pulmonary findings completely disappeared with glucocorticoid and pulse cyclophosphamide treatment. These findings show that diabetes insipidus may rarely develop early in the disease process and ANCA positivity was directly indicative of Wegener's granulomatosis before the classic clinical signs of the disease. |
| Databáze: | OpenAIRE |
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