Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis

Detalhes bibliográficos
Autor(a) principal: Pimentel-Nunes, Pedro
Data de Publicação: 2009
Outros Autores: Guerrero, Hector, Esteves, Afonso
Tipo de documento: Artigo
Idioma: por
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1402
Resumo: We describe a clinical case of a 43 year-old-man recurring to Emergency Department with persistent arthralgias and acute renal failure. A recent hospital admission due to communityacquired pneumonia with pleural effusion and irregular nodules in Computed Tomography (CT) scan was noticeable. Study of renal failure revealed pauci-imune necrotizing nephropathy with positive anti-proteinase 3 ANCA (PR3-ANCAs) establishing the diagnosis of Wegener’s Granulomatosis. He began treatment with prednisolone and cyclophosphamide (CFA), being released from hospital clinically improved. Ten days after discharge, he was readmitted to hospital because of a hyperglicemic hyperosmolar state. Even with dose reduction of steroids and CFA, long term therapy with insulin in order to obtain glicemic control was needed. Such presentation of diabetes mellitus as hyperglicemic hyperosmolar state within few days after beginning therapy with steroids in a previously normoglicemic patient is rare. We believe that CFA had an important role in this patient with propensity to auto-immunity phenomena. Similar to what happens in rats and already shown also in humans, CFA might have selected a clone of auto-reactive T-cells that promoted the auto-immune destruction of β-pancreatic cells.
id RCAP_e1fe17432d131d68cee9f053ca686972
oai_identifier_str oai:oai.revista.spmi.pt:article/1402
network_acronym_str RCAP
network_name_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository_id_str 7160
spelling Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s GranulomatosisEstado hiperosmolar hiperglicémico: Um efeito lateral raro da terapêutica com prednisolona e ciclofosfamida na Granulomatose de WegenerGranulomatose de Wegenerdiabetes mellitusestado hiperosmolar hiperglicémicocorticoesteróidesciclofosfamidavasculiteWegener’s GranulomatosisDiabetes mellitushyperglicemic hiperosmolar statecorticosteroidscyclophosphamidevasculitiWe describe a clinical case of a 43 year-old-man recurring to Emergency Department with persistent arthralgias and acute renal failure. A recent hospital admission due to communityacquired pneumonia with pleural effusion and irregular nodules in Computed Tomography (CT) scan was noticeable. Study of renal failure revealed pauci-imune necrotizing nephropathy with positive anti-proteinase 3 ANCA (PR3-ANCAs) establishing the diagnosis of Wegener’s Granulomatosis. He began treatment with prednisolone and cyclophosphamide (CFA), being released from hospital clinically improved. Ten days after discharge, he was readmitted to hospital because of a hyperglicemic hyperosmolar state. Even with dose reduction of steroids and CFA, long term therapy with insulin in order to obtain glicemic control was needed. Such presentation of diabetes mellitus as hyperglicemic hyperosmolar state within few days after beginning therapy with steroids in a previously normoglicemic patient is rare. We believe that CFA had an important role in this patient with propensity to auto-immunity phenomena. Similar to what happens in rats and already shown also in humans, CFA might have selected a clone of auto-reactive T-cells that promoted the auto-immune destruction of β-pancreatic cells.Os autores descrevem o caso de um doente do sexo masculino, de 43 anos de idade, com história de internamento recente por pneumonia da comunidade com derrame pleural e nódulos irregulares na tomografia computorizada (TC), que recorreu novamente ao Serviço de Urgência por artralgias persistentes. No estudo analítico efectuado identificou-se insuficiência renal de novo, motivo pelo qual se resolveu pelo internamento. Na sequência do estudo da insuficiência renal, evidenciou-se nefropatia necrozante pauci-imune com ANCAs antiproteinase 3 (PR3-ANCAs) positivos, estabelecendo-se o diagnóstico de granulomatose de Wegener. Iniciou tratamento com prednisolona e ciclofosfamida (CFA), tendo tido alta clinicamente melhorado. Dez dias após a alta, o doente apresentou-se em estado hiperosmolar hiperglicémico, razão pela qual foi de novo internado. Mesmo com redução das doses de corticóides e CFA verificou-se, a longo prazo, necessidade de terapêutica com insulina, para controlo glicémico.O aparecimento de diabetes mellitus na forma de estado hiperosmolar hiperglicémico em doentes previamente normoglicémicos e poucos dias após início da terapêutica com corticóides é raro. Parece-nos que a CFA terá tido papel importante neste doente, propenso para fenómenos auto-imunes, podendo ter seleccionado um clone de células T-autorreactivas que terão levado à destruição auto-imune das células β-pancreáticas, à semelhança do que ocorre em ratos e também já evidenciado em humanosSociedade Portuguesa de Medicina Interna2009-06-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spmi.pt/index.php/rpmi/article/view/1402Internal Medicine; Vol. 16 No. 2 (2009): Abril/ Junho; 106-111Medicina Interna; Vol. 16 N.º 2 (2009): Abril/ Junho; 106-1112183-99800872-671Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spmi.pt/index.php/rpmi/article/view/1402https://revista.spmi.pt/index.php/rpmi/article/view/1402/956Pimentel-Nunes, PedroGuerrero, HectorEsteves, Afonsoinfo:eu-repo/semantics/openAccess2022-12-31T06:11:44Zoai:oai.revista.spmi.pt:article/1402Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:29:10.598164Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
Estado hiperosmolar hiperglicémico: Um efeito lateral raro da terapêutica com prednisolona e ciclofosfamida na Granulomatose de Wegener
title Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
spellingShingle Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
Pimentel-Nunes, Pedro
Granulomatose de Wegener
diabetes mellitus
estado hiperosmolar hiperglicémico
corticoesteróides
ciclofosfamida
vasculite
Wegener’s Granulomatosis
Diabetes mellitus
hyperglicemic hiperosmolar state
corticosteroids
cyclophosphamide
vasculiti
title_short Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
title_full Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
title_fullStr Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
title_full_unstemmed Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
title_sort Hyperglycemic hyperosmolar state: A rare adverse effect of prednisolone and cyclophosphamide therapy in Wegener’s Granulomatosis
author Pimentel-Nunes, Pedro
author_facet Pimentel-Nunes, Pedro
Guerrero, Hector
Esteves, Afonso
author_role author
author2 Guerrero, Hector
Esteves, Afonso
author2_role author
author
dc.contributor.author.fl_str_mv Pimentel-Nunes, Pedro
Guerrero, Hector
Esteves, Afonso
dc.subject.por.fl_str_mv Granulomatose de Wegener
diabetes mellitus
estado hiperosmolar hiperglicémico
corticoesteróides
ciclofosfamida
vasculite
Wegener’s Granulomatosis
Diabetes mellitus
hyperglicemic hiperosmolar state
corticosteroids
cyclophosphamide
vasculiti
topic Granulomatose de Wegener
diabetes mellitus
estado hiperosmolar hiperglicémico
corticoesteróides
ciclofosfamida
vasculite
Wegener’s Granulomatosis
Diabetes mellitus
hyperglicemic hiperosmolar state
corticosteroids
cyclophosphamide
vasculiti
description We describe a clinical case of a 43 year-old-man recurring to Emergency Department with persistent arthralgias and acute renal failure. A recent hospital admission due to communityacquired pneumonia with pleural effusion and irregular nodules in Computed Tomography (CT) scan was noticeable. Study of renal failure revealed pauci-imune necrotizing nephropathy with positive anti-proteinase 3 ANCA (PR3-ANCAs) establishing the diagnosis of Wegener’s Granulomatosis. He began treatment with prednisolone and cyclophosphamide (CFA), being released from hospital clinically improved. Ten days after discharge, he was readmitted to hospital because of a hyperglicemic hyperosmolar state. Even with dose reduction of steroids and CFA, long term therapy with insulin in order to obtain glicemic control was needed. Such presentation of diabetes mellitus as hyperglicemic hyperosmolar state within few days after beginning therapy with steroids in a previously normoglicemic patient is rare. We believe that CFA had an important role in this patient with propensity to auto-immunity phenomena. Similar to what happens in rats and already shown also in humans, CFA might have selected a clone of auto-reactive T-cells that promoted the auto-immune destruction of β-pancreatic cells.
publishDate 2009
dc.date.none.fl_str_mv 2009-06-30
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://revista.spmi.pt/index.php/rpmi/article/view/1402
url https://revista.spmi.pt/index.php/rpmi/article/view/1402
dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv https://revista.spmi.pt/index.php/rpmi/article/view/1402
https://revista.spmi.pt/index.php/rpmi/article/view/1402/956
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Medicina Interna
publisher.none.fl_str_mv Sociedade Portuguesa de Medicina Interna
dc.source.none.fl_str_mv Internal Medicine; Vol. 16 No. 2 (2009): Abril/ Junho; 106-111
Medicina Interna; Vol. 16 N.º 2 (2009): Abril/ Junho; 106-111
2183-9980
0872-671X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
_version_ 1799130749117399040

Registros relacionados