Azathioprine (AZA) is used in a wide array of autoimmune diseases, still corresponding to the mainstay maintenance therapy in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Although generally well-tolerated, several side effects are recognized. We report the case of a 50-yearold Caucasian man with kidney-limited ANCA myeloperoxidase (MPO) vasculitis who presented with general malaise, fever, worsening renal function, and elevated inflammatory markers 2 weeks after the initiation of therapy with oral AZA. Although a disease relapse was suspected, renal biopsy revealed an eosinophilic infiltrate, suggestive of acute interstitial nephritis. After suspension of AZA, a sustained improvement of renal function and normalization of inflammatory markers was observed. A diagnosis of allergic interstitial nephritis secondary to AZA was established, corresponding to the first biopsy-proven case described in an ANCA MPO vasculitis patient. Although rare, renal toxicity of AZA must be present in the clinician´s mind, avoiding the straightforward assumption of disease relapse in the case of worsening renal function.
Multiple symmetric lipomatosis or Madelung's disease is a rare condition which is characterized by multiple symmetric and disfiguring accumulation of non-capsulated fat tissue depositions mostly in upper arms, neck, and shoulder areas. The disease etiology is unknown, with the highest incidence in the Mediterranean region and an association with alcohol abuse. We present a case of a patient admitted to our internal medicine department for cervical mass study. This patient was already studied by his general practitioner because of thyroid disease suspicion. During our study, diagnosis of Madelung's disease with typical fat depositions was established. This article is a short review of the topic and points out the possible diagnostic difficulties presented in early stages of the disease.
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