Castleman disease (CD) is a disorder characterized by lymphoid proliferation. It is not usually the first differential for pyrexia of unknown origin (PUO) because of the extremely rare incidence worldwide. We report the case of a 24-year-old man with PUO for six months. He had been previously investigated for infective, rheumatological, and immunological causes. Extrapulmonary tuberculosis was considered as the most likely diagnosis because of his clinical presentation and locality. Based on this, he was given a trial of anti-tuberculous therapy. However, he did not show any signs of improvement despite being compliant with the medications. His condition was further complicated by the development of ascites. Upon treatment failure, the patient presented to our tertiary care hospital and was investigated for a possible revision of diagnosis. Based on clinical assessment and histopathology of the lymph nodes, he was diagnosed with idiopathic multicentric CD overlapping with systemic lupus erythematosus. He was started on azathioprine and prednisone and showed a positive response, indicated by a decreasing erythrocyte sedimentation rate and C-reactive protein. The patient continues to be healthy and in remission to date.
Background: Angiotensin I is converted to angiotensin II by an angiotensin-converting enzyme, which is an important component of renin-angiotensin framework. Multifactorial chronic kidney disease includes risk factors such as hypertension, obesity, inherited factors, and diabetes. A genetic factor associated with premature signs of renal failure is predominantly increased arterial hypertension and albumin excretion, which add to the pathophysiological movement of disintegration in renal capacity. This enzymatic assay aimed to detect ACE levels in various renal patients compared with controls to confirm the relationship between ACE quality polymorphism and enzymatic ACE levels. Materials and Methods: The study population of our study included 56 patients with chronic kidney disease. Who was confirmed to have chronic kidney disease after being diagnosed in the dialysis ward of the tertiary care hospital. Results: A total of 56 chronic kidney disease were enrolled. Mean age of patients were 55.1±13.6. Among total recruited patients, 60% male patients and 40% were female patients. The HDL, and LDL were lower in chronic kidney disease patients than control group. While BMI, total cholestrol, triglyceride, systolic blood pressure, diastolic blood pressure, and ACE level were found higher in CKD patients than control group. The frequency of genotypes ACE II, ID, and DD in patients groups was 12 (12.43%), 28 (48.21%), and 17 (30.35%). Conclusion: Our study result indicates that the D allele is involved in the progression of chronic diseases. When we look at the frequency of I and D alleles it clearly shows that the frequency of the D allele is significantly higher in patients with CKD than the frequency of the I allele. Keywords: ACE, CKD, Renal patients, Polymorphism
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