Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report

Detalhes bibliográficos
Autor(a) principal: Martins,Julia Izadora da Silva
Data de Publicação: 2019
Outros Autores: Bertoglio,Isabela Maria, Guerra,Amanda Carolina Damasceno Zanuto, Maioli,Mariana Espiga, Delfino,Vinicius Daher Alvares
Tipo de documento: Relatório
Idioma: eng
Título da fonte: Jornal Brasileiro de Nefrologia
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019000200296
Resumo: ABSTRACT Introduction: Purpura fulminans (PF) is a rapid progressive thrombotic disease in which hemorrhagic infarction of the skin and disseminated intravascular coagulation (DIC) occurs. It can potentially cause acute kidney injury (AKI). However, there is no description in the medical literature of renal histological findings of PF. Case report: A 20-year-old female patient, previously healthy, was admitted to the emergency department (ED) with odynophagia, fever, generalized myalgia and anuria, which evolved with the appearance of purpuric plaques on the face and limbs. She required dialysis on admission. Laboratorial tests showed anemia, leukocytosis, thrombocytopenia, and elevation of lactic dehydrogenase (LDH). The purpuric lesions became bullous with ruptures and then necrotic and erosive, reaching the dermis, subcutaneous tissue and musculature, until bone exposure. There was no improvement with initial antibiotic therapy aimed at the treatment of meningococcemia. Thrombotic microangiopathy (TMA) and PF were then suspected. The patient remained in daily dialysis, requiring plasmapheresis. After sustained improvement of the thrombocytopenia, she underwent renal biopsy, which was not compatible with TMA, characterizing possible PF. A complete recovery of the renal function was achieved and cutaneous sequels were treated with grafts. Conclusion: When thrombotic and hemorrhagic phenomena overlap, obtaining a renal biopsy can be difficult. However, in the presented case, the biopsy allowed the exclusion of AKI caused by TMA, presenting for the first time, histological findings compatible with PF.
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spelling Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case reportPurpura FulminansThrombotic MicroangiopathiesAcute Kidney InjuryBiopsyABSTRACT Introduction: Purpura fulminans (PF) is a rapid progressive thrombotic disease in which hemorrhagic infarction of the skin and disseminated intravascular coagulation (DIC) occurs. It can potentially cause acute kidney injury (AKI). However, there is no description in the medical literature of renal histological findings of PF. Case report: A 20-year-old female patient, previously healthy, was admitted to the emergency department (ED) with odynophagia, fever, generalized myalgia and anuria, which evolved with the appearance of purpuric plaques on the face and limbs. She required dialysis on admission. Laboratorial tests showed anemia, leukocytosis, thrombocytopenia, and elevation of lactic dehydrogenase (LDH). The purpuric lesions became bullous with ruptures and then necrotic and erosive, reaching the dermis, subcutaneous tissue and musculature, until bone exposure. There was no improvement with initial antibiotic therapy aimed at the treatment of meningococcemia. Thrombotic microangiopathy (TMA) and PF were then suspected. The patient remained in daily dialysis, requiring plasmapheresis. After sustained improvement of the thrombocytopenia, she underwent renal biopsy, which was not compatible with TMA, characterizing possible PF. A complete recovery of the renal function was achieved and cutaneous sequels were treated with grafts. Conclusion: When thrombotic and hemorrhagic phenomena overlap, obtaining a renal biopsy can be difficult. However, in the presented case, the biopsy allowed the exclusion of AKI caused by TMA, presenting for the first time, histological findings compatible with PF.Sociedade Brasileira de Nefrologia2019-06-01info:eu-repo/semantics/reportinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019000200296Brazilian Journal of Nephrology v.41 n.2 2019reponame:Jornal Brasileiro de Nefrologiainstname:Sociedade Brasileira de Nefrologia (SBN)instacron:SBN10.1590/2175-8239-jbn-2018-0074info:eu-repo/semantics/openAccessMartins,Julia Izadora da SilvaBertoglio,Isabela MariaGuerra,Amanda Carolina Damasceno ZanutoMaioli,Mariana EspigaDelfino,Vinicius Daher Alvareseng2019-07-29T00:00:00Zoai:scielo:S0101-28002019000200296Revistahttp://www.bjn.org.br/ONGhttps://old.scielo.br/oai/scielo-oai.php||jbn@sbn.org.br2175-82390101-2800opendoar:2019-07-29T00:00Jornal Brasileiro de Nefrologia - Sociedade Brasileira de Nefrologia (SBN)false
dc.title.none.fl_str_mv Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
title Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
spellingShingle Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
Martins,Julia Izadora da Silva
Purpura Fulminans
Thrombotic Microangiopathies
Acute Kidney Injury
Biopsy
title_short Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
title_full Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
title_fullStr Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
title_full_unstemmed Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
title_sort Renal histological findings in a patient with acute renal injury associated with purpura fulminans: a case report
author Martins,Julia Izadora da Silva
author_facet Martins,Julia Izadora da Silva
Bertoglio,Isabela Maria
Guerra,Amanda Carolina Damasceno Zanuto
Maioli,Mariana Espiga
Delfino,Vinicius Daher Alvares
author_role author
author2 Bertoglio,Isabela Maria
Guerra,Amanda Carolina Damasceno Zanuto
Maioli,Mariana Espiga
Delfino,Vinicius Daher Alvares
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Martins,Julia Izadora da Silva
Bertoglio,Isabela Maria
Guerra,Amanda Carolina Damasceno Zanuto
Maioli,Mariana Espiga
Delfino,Vinicius Daher Alvares
dc.subject.por.fl_str_mv Purpura Fulminans
Thrombotic Microangiopathies
Acute Kidney Injury
Biopsy
topic Purpura Fulminans
Thrombotic Microangiopathies
Acute Kidney Injury
Biopsy
description ABSTRACT Introduction: Purpura fulminans (PF) is a rapid progressive thrombotic disease in which hemorrhagic infarction of the skin and disseminated intravascular coagulation (DIC) occurs. It can potentially cause acute kidney injury (AKI). However, there is no description in the medical literature of renal histological findings of PF. Case report: A 20-year-old female patient, previously healthy, was admitted to the emergency department (ED) with odynophagia, fever, generalized myalgia and anuria, which evolved with the appearance of purpuric plaques on the face and limbs. She required dialysis on admission. Laboratorial tests showed anemia, leukocytosis, thrombocytopenia, and elevation of lactic dehydrogenase (LDH). The purpuric lesions became bullous with ruptures and then necrotic and erosive, reaching the dermis, subcutaneous tissue and musculature, until bone exposure. There was no improvement with initial antibiotic therapy aimed at the treatment of meningococcemia. Thrombotic microangiopathy (TMA) and PF were then suspected. The patient remained in daily dialysis, requiring plasmapheresis. After sustained improvement of the thrombocytopenia, she underwent renal biopsy, which was not compatible with TMA, characterizing possible PF. A complete recovery of the renal function was achieved and cutaneous sequels were treated with grafts. Conclusion: When thrombotic and hemorrhagic phenomena overlap, obtaining a renal biopsy can be difficult. However, in the presented case, the biopsy allowed the exclusion of AKI caused by TMA, presenting for the first time, histological findings compatible with PF.
publishDate 2019
dc.date.none.fl_str_mv 2019-06-01
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Nefrologia
publisher.none.fl_str_mv Sociedade Brasileira de Nefrologia
dc.source.none.fl_str_mv Brazilian Journal of Nephrology v.41 n.2 2019
reponame:Jornal Brasileiro de Nefrologia
instname:Sociedade Brasileira de Nefrologia (SBN)
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