Acute reversible renal failure with macroscopic hematuria in Henoch-Schönlein purpura

A Japanese girl aged 5 years 4 months developed macroscopic hematuria and acute renal failure (ARF) 8 days before the appearance of purpura rash. A renal biopsy undertaken during the acute phase of illness revealed many red blood cells in the tubular lumina with no apparent glomerular lesions. ARF showed improvement without dialysis therapy. A second renal biopsy was performed 2.5 months later because of the prolonged proteinuria and hematuria. Sclerotic change and crescent formation were demonstrated in 30% and 20% of glomeruli, respectively. Red blood cell casts in the tubular lumina were completely resolved. It is likely that the tubular change was involved in the development of ARF at the onset of illness. Although ARF during or after episodes of macroscopic hematuria has been observed in IgA nephropathy, it may occur as an uncommon complication in Henoch-Schönlein nephritis, which is a common glomerulonephritis in children.

Pneumoperitoneum complicating mechanical ventilation in congenital myotonic dystrophy

Pneumoperitoneum is known as a disease caused by perforation of the gastrointestinal tract, but it has also been reported as a complication of mechanical ventilation. In a case of congenital myotonic dystrophy (CMyD), mechanical ventilation was performed to treat severe respiratory distress starting at birth, and then pneumomediastinum and pneumoperitoneum developed as complications 5 days after birth. The fact that the pneumoperitoneum improved when the ventilation pressure was reduced and the patient's course was observed, allowed us to rule out gastrointestinal perforation. It appeared that hypoplasia of the diaphragm may have been involved in the progression of pneumomediastinum to pneumoperitoneum in this patient. Mechanical ventilation is performed on many occasions in CMyD, and the development of pneumoperitoneum secondary to pulmonary air leak should always be borne in mind.

[Successful gamma-globulin pulse therapy of a young child with acquired pure red cell aplasia]

We report a case of a 2 years and 2 months old male, who showed a normochromic normocytic anemia, Hb 3.7g/dl. The bone marrow aspiration revealed a remarkable decrease of erythroblasts alone. Because of none of other underlying diseases identified, it leads to a diagnosis of acquired idiopathic pure red cell aplasia (PRCA). Pulse therapy of methylprednisolone, followed by one month administration of prednisone did not lead to a remission. However, high dose of gamma-globulin pulse therapy restored erythropoiesis in several days, with a rate of hemoglobin increment of 0.5 g/dl/day. 2.5 years after the onset of PRCA, the patient has neither suffered from complications of hematological diseases, nor undesired consequences of the therapy. Although recent advance of therapy regarding PRCA has focussed on cyclosporine A, high dose of gamma-globulin pulse therapy with a remarkable effect is worth as an alternative.