Acute Kidney Injury and Diffuse Pulmonary Hemorrhage Secondary to IgA Nephropathy and Henoch-Schönlein Purpura: A Case Report

IgA nephropathy (IgAN), characterized as immune complex-mediated glomerulonephritis, can occasionally manifest alongside the pulmonary-renal syndrome. Henoch-Schönlein purpura (HSP), an inflammatory condition affecting small vessels through leukocytoclastic vasculitis, exhibits a close association with IgA nephropathy. Nonetheless, HSP's infrequent complications encompass pulmonary hemorrhage. Notably, the onset of pulmonary hemorrhage can rapidly precipitate a grave decline in the patient's health status, carrying a potentially fatal outcome for both disorders. Moreover, the existing literature regarding this specific complication and its management, particularly among adults, remains relatively limited. We report a rare case of a 43-year-old male with acute renal failure secondary to IgA nephropathy associated with HSP, whose condition was further complicated by pulmonary hemorrhage. He was treated with extensive plasmapheresis, pulse steroids, rituximab, and cyclophosphamide, which led to the successful recovery of his kidney function. Recognizing the potential of various presentations can significantly contribute to early diagnosis and prompt treatment, potentially leading to an improved prognosis for these patients.

The Diagnostic and Therapeutic Dilemma of Seronegative Pulmonary Renal Syndrome: A Case Report

Pulmonary renal syndrome (PRS) is a combination of rapid progressive glomerulonephritis (RPGN) and diffuse alveolar hemorrhage (DAH) caused by a variety of immunological and non-immunological etiologies. The difficulty in identifying and reporting seronegative PRS cases could be attributed to the lack of specific immunological markers. Thus, we report a rare case of a 13-year-old boy who was initially diagnosed with idiopathic pauci-immune pulmonary capillaritis (IPIPC). A year later, his condition became complicated, and was referred for further workup. During his hospital stay, he underwent a renal biopsy that showed stage II membranous nephropathy (MN). He tested negative for immunological markers and a diagnosis of seronegative PRS was established. He responded well to the immunosuppression therapy with monthly follow-ups. As in our patient, PRS may manifest as acute renal failure symptoms and non-specific respiratory symptoms that require extensive workup. The severity of the disease is inferred from the renal function at the time of presentation. Management involves immunosuppression and treatment of the underlying condition, with dialysis dependency occurring in a significant percentage of patients and a high mortality rate, especially in critically ill and older patients. In conclusion, timely diagnosis and treatment are essential given the condition's rapid progression and high mortality rate.

Clinical and epidemiological aspects of herpes zoster disease in a primary care setting in Riyadh, Saudi Arabia: A retrospective cohort study

Context

Herpes zoster (HZ), or shingles, is one of the most common infectious diseases. HZ can be associated with other diseases, such as cancer and immunocompromised conditions. Thus, early recognition of the disease characteristics and clinical manifestations is critical to decrease the disease burden and to avoid further complications.

Aim

To assess the epidemiology of HZ disease, its clinical manifestations, coexisting and post-existing conditions, complications, and management among patients in a primary care setting.

Subjects and Methods

This was a retrospective, single-armed, cohort study. Data of all patients diagnosed with HZ, aged 18 years and older, who visited the Family Medicine Department at King Faisal Specialist Hospital and Research Center from January 2014 to August 2021 were reviewed from their medical records. All data analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) statistical software, version 20.0.

Results

A total of 330 cases were included over the study period. The male-to-female ratio was 1:2, with a higher occurrence of HZ (44.5%) in those aged ≥ 50 years. Only 4.5% of the patients were recipients of zoster vaccines. Thoracic dermatome was the most affected dermatome (38%). The most common coexisting disease was diabetes (21.5%). The most common post-existing disease was cardiovascular disease (3%), and the most common complication was postherpetic neuralgia (15.2%). Suboptimal dosage of acyclovir was the most commonly used treatment for HZ infections (69.7%).

Conclusions

Zoster vaccination uptake was low. A national program for adult vaccination, including zoster vaccination, should be developed, and a guideline to direct primary health-care professionals in the management of HZ infections should be implemented.