1/32. Tubulointerstitial nephritis associated with minimal self reexposure to rifampin.We report the case of a 27-year-old Asian man who self-medicated with two capsules of rifampin 1 year after completing a continuous course of chemotherapy for tuberculosis that included that drug. He developed flank pain and edema and presented with uremia requiring dialysis; despite this, he had a serum potassium of only 3.5 mEq/L. Renal biopsy showed interstitial infiltrate with inflammation of the tubules. Renal function began to improve after a 3-week course of prednisone. This case is remarkable for the severity of the renal failure despite such a minimal self-exposure.- - - - - - - - - - ranking = 1keywords = nephritis, interstitial (Clic here for more details about this article) |
2/32. Acute tubulo-interstitial nephritis requiring dialysis associated with intermittent rifampicin use: case report.Rifampicin is one of the most effective antibiotics used for the treatment of tuberculosis and severe staphylococcal infections. Intermittent administration of high doses of rifampicin has been associated with frequent adverse reactions, including hepatotoxicity and nephrotoxicity, sometimes resulting in acute renal failure. We describe a case of rifampicin-associated acute renal failure, with biopsy findings of tubulointerstitial nephritis; inflammatory cells were characterized by immunohistochemistry, which showed immunoreactivity for CD3 and CD5 (T lymphocytes) and for CD68 (macrophages). The patient presented with a very rapid systemic reaction to the offending drug and rapid deterioration of renal function, which required dialysis treatment. The response to rifampicin discontinuation was excellent: no further therapy was required, as renal function began to improve within several days and returned to normal values (serum creatinine 1.17 mg/dl) seven months after the onset of symptoms. When prescribing rifampicin the physician should investigate previous use of the drug, because re-exposure is a critical factor in predicting the possibility of drug-induced acute renal failure.- - - - - - - - - - ranking = 2.2617517337616keywords = tubulointerstitial, tubulointerstitial nephritis, nephritis, interstitial (Clic here for more details about this article) |
3/32. Hard metal lung disease--the first case in singapore.INTRODUCTION: We report the first case of hard metal lung disease in singapore and the occupational investigative work and control measures that were undertaken. CLINICAL PICTURE: A 38-year-old machinist in the tool manufacturing industry presented with exertional dyspnoea and cough. Chest X-ray revealed bilateral reticulonodular infiltrates with honeycombing. High resolution computed tomography scan of the thorax confirmed the presence of interstitial fibrosis. Open biopsy of the lung showed features of pneumoconiosis. Particle induced X-ray emission (PIXE) analysis, a relatively new elemental analysis technique, performed on the lung biopsy specimen confirmed the presence of tungsten and titanium; and he was diagnosed to have hard metal lung disease. Microbiologic, serologic and histologic investigations excluded an infective cause. Serial pulmonary function tests on follow-up showed no progression. He presented with haemoptysis 10 months later and was diagnosed to have tuberculosis on the basis of positive sputum and bronchoalveolar lavage cultures for mycobacterium tuberculosis complex. TREATMENT: Preventive measures and permanent transfer to non-cobalt work were instituted. OUTCOME: The interstitial fibrosis appears to have stabilised. CONCLUSION: The diagnosis of hard metal lung disease must be considered in a worker exposed to cobalt presenting with interstitial fibrosis.- - - - - - - - - - ranking = 0.034814442813789keywords = interstitial (Clic here for more details about this article) |
4/32. Acute lupus pneumonitis mimicking pulmonary tuberculosis: a case report.We report a case of systemic lupus erythematosus in a 15-year-old girl with initial presentation as acute lupus pneumonitis. A fulminant course with pancytopenia and respiratory distress were developed 3 weeks after symptom onset. Chest radiographs revealed an interstitial pattern with miliary nodules over bilateral lower lung fields that mimics miliary tuberculosis. The patient was treated with intravenous immunoglobulin and antituberculosis drugs because the infection-associated hemophagocytic syndrome and pulmonary tuberculosis could not be excluded from the clinical course. The response to antituberculosis treatment, however, was poor and her respiratory condition deteriorated rapidly to impending respiratory failure 1 week after admission. Systemic lupus erythematosus with acute lupus pneumonitis was then diagnosed based on the fulminant clinical course and accordant laboratory results. Corticosteroid (methylprednisolone) and cytotoxic agent (cyclophosphamide) pulse therapies were applied twice and once, respectively. She recovered gradually after receiving the immunotherapy.- - - - - - - - - - ranking = 0.011604814271263keywords = interstitial (Clic here for more details about this article) |
5/32. pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult hiv negative patient.This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having hiv infection, based on risk factor analyses, but was subsequently shown to be hiv negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for mycobacterium tuberculosis and pneumocystis carinii, and stool tests were positive for strongyloides stercoralis and schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the hiv tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his hiv ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as hiv infection. The occurrence of opportunistic infections in severely ill patients without hiv must always be considered and alternate causes of immunosuppression sought.- - - - - - - - - - ranking = 0.011604814271263keywords = interstitial (Clic here for more details about this article) |
6/32. Treatment of systemic lupus erythematosus by immunoadsorption in a patient suffering from tuberculosis.We report on a 40-year-old man, admitted with fever and weight loss, in whom systemic lupus erythematosus (lupus nephritis world health organization type IV) and concomitant acute lung tuberculosis were diagnosed. Conventional treatment of diffuse proliferative nephritis with cytotoxic drugs was thought to be too dangerous in the presence of active tuberculosis. A combination of immunoadsorption and steroids was instituted for the treatment of systemic lupus erythematosus. antibodies against double-stranded dna decreased, and proteinuria decreased from 10 g/24 hours to less than 1 g/24 hours. Tuberculosis was treated initially with quadruple-drug therapy, then a triple-drug protocol. Primarily enlarged lymph nodes decreased to normal size after 3 months. The combined treatment modality of steroids and immunoadsorption was effective and safe, even in this patient with active tuberculosis.- - - - - - - - - - ranking = 0.47098796432184keywords = nephritis (Clic here for more details about this article) |
7/32. Crescentic glomerulonephritis associated with rifampicin in a patient co-infected with tuberculosis and human immunodeficiency virus.A 73-year-old man presented with acute renal failure after 3-month standard antituberculosis therapy with rifampicin for pulmonary tuberculosis. Previously undiagnosed human immunodeficiency virus (hiv) infection was found at the same time. A kidney biopsy showed crescentic glomerulonephritis and tubulointerstitial nephritis. Furthermore, endothelial tubuloreticular inclusions were seen on electron microscopy. Rifampicin was stopped because it was considered as the most possible cause responsible for the rapidly progressive glomerulonephritis (RPGN). Immunosuppressive therapy was not carried out because of the risk of aggravation of underlying infectious diseases including tuberculosis and hiv. Fortunately, renal function recovered 1 month after discontinuation of rifampicin. This case presented a clinical challenge in the differential diagnosis of the cause for RPGN in such a complex condition and the therapeutic dilemma regarding the use of immunosuppressive drugs.- - - - - - - - - - ranking = 2.6863204409984keywords = tubulointerstitial, tubulointerstitial nephritis, nephritis, interstitial (Clic here for more details about this article) |
8/32. Immune complex glomerulonephritis secondary to tuberculosis.A 63 year old man with pulmonary tuberculosis developed nephrotic syndrome secondary to immune complex nephritis. The nephrotic syndrome and renal lesion resolved with standard chemotherapy.- - - - - - - - - - ranking = 1.1774699108046keywords = nephritis (Clic here for more details about this article) |
9/32. Disseminated mycobacterium fortuitum successfully treated with combination therapy including ciprofloxacin.We report a case of disseminated mycobacterium fortuitum in a 76-yr-old male with no identifiable predisposing factors except chronic interstitial lung disease. Recurrent, progressive pulmonary symptoms and radiographic findings were followed by the development of multiple, culture-positive peripheral lesions. The patient responded rapidly and completely to combination therapy consisting primarily of ciprofloxacin, minocycline, and surgical drainage. Our experience supports the cautious use and further study of fluorinated quinolones for M. fortuitum infections caused by susceptible isolates.- - - - - - - - - - ranking = 0.011604814271263keywords = interstitial (Clic here for more details about this article) |
10/32. Tubulointerstitial nephritis associated with pyrazinamide.Modern antituberculous therapy consists of a combination of several drugs, some of which (e.g. rifampicin and streptomycin) may cause impairment of renal function. pyrazinamide therapy has been associated with dose-dependent hepatotoxicity, hyperuricaemia, arthralgia and arthritis. The patient described in this report developed renal failure, fever, arthritis and arthralgia during administration of isoniazid, rifampicin, streptomycin and pyrazinamide. The renal biopsy showed tubulo-interstitial nephritis. After withdrawal of pyrazinamide, while continuing all other drugs, both renal function and histological findings improved which points to an association of renal failure with pyrazinamide.- - - - - - - - - - ranking = 1.2354939821609keywords = nephritis, interstitial (Clic here for more details about this article) |
| | Next -> |