We describe a case of a patient who developed microscopic polyangiitis (MPA) in the setting of exposure to silicone after breast implantation. A 57-year-old Hispanic woman was admitted to our hospital with complaints of fever, cough, and hemoptysis. She had undergone silicone breast implantation two years prior to presentation. She was diagnosed as having microscopic polyangiitis (MPA) based on acute progressive renal failure, hematuria, pulmonary hemorrhage, and positivity for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA). A renal biopsy performed showed focal segmental necrotizing and crescentic glomerulonephritis. The patient received high dose steroids, cyclophosphamide, and plasmapheresis with remarkable clinical response. This case report raises the possibility of the development of MPA after silicone exposure from breast implantation.
Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare but important cause of stroke-like symptoms which can often be missed Thambisetty and Newman 2004. We describe a case of a young male presenting with stroke-like episodes, later diagnosed with MELAS in an attempt to improve the understanding about diagnosing MELAS in the appropriate clinical context.
Approximately 10% of patients treated with erythropoiesis-stimulating agents
(ESAs) for the anemia of chronic kidney disease are unresponsive or relatively resistant
to therapy. The etiology of this is usually linked to iron deficiency or an independent
underlying illness. We describe a hemodialysis patient with a failed renal transplant 1.5
years earlier, who developed progressive erythropoietin resistance and anemia without an
apparent cause. He simultaneously developed nonspecific malaise and fatigue. By exclusion,
the only possible cause of these signs and symptoms was inflammation from acute and
chronic rejection in the retained failed renal allograft. Following pulse steroids and
transplant nephrectomy, the patient's symptoms resolved and both his hemoglobin improved
and his erythropoietin requirements decreased significantly. The patient never required a
blood transfusion and was successfully re-listed for a deceased donor renal transplant.
Hence, inflammation from a retained transplant allograft may be an under-recognized cause
of erythropoietin resistance in dialysis patients. Although transplant nephrectomy remains
a controversial practice due to concerns of alloantibody production, it may be considered
in patients with failed renal allografts and anemia refractory to treatment with ESAs.
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