Lege Artis Medicinae

[Polyneuropathy as a first sign of microscopic polyangiitis]

ZÖLD Éva1, HORVÁTH Ildikó Fanny1, TARJÁN Péter2, BARTA Zsolt3, ZEHER Margit1

SEPTEMBER 21, 2014

Lege Artis Medicinae - 2014;24(08-09)

[INTRODUCTION - Microscopic polyangiitis (MPA) is a systemic autoimmun disease characterized by necrotizing small vasculitis. MPA belongs to the ANCA-associated vasculitides. The disease can affect many of the body’s organ systems. Major organs involved are kidneys, skin, peripheral nerves and lungs. In addition, generalized symptoms such as fever and weight loss are very common. CASE REPORT - In January 2013 a 56-year old woman presented with weight loss, lower leg numbness, walking difficulty and petechiae on the lower legs. One month later, laboratory examinations showed progressive kidney dysfunction, anemia, hypersedimentation and elevated C reactive protein level, but further tests and investigations for potential bacterial infection and tumors were all negative. In sum, clinical signs and symptoms suggested systemic vasculitis, which was proved by the kidney biopsy and ENG examination. From these findings, microscopic polyangiitis was diagnosed with polyneuropathy and glomerulonephritis. The patient was a Hepatitis B (HBV) virus carrier, which can be provoking factor for vasculitis. Corticosteroid and six treatment cycles of intravenous pulse cyclophosphamide were performed for induction of remission. After treatment her symptoms improved and kidney function was normalized. Antiviral treatment was started because of HBV reactivation in October 2013. As a new manifestation of MPA, pulmonary symptoms were appeared in November 2013 and the patient was treated with synchronization of plasmapheresis and pulse cyclophosphamide with good clinical effectivity. Now, she is treated with methotrexate as immunosuppressive treatment and control examinations indicate the remission of the disease with proper renal function. CONCLUSION - We draw attention to a rare case of vasculitis and underline the importance of both the early diagnosis and the early and effective immunosuppressive therapy. Peripheral neuropathy may occur as a result of having systemic vasculitis. Nevertheless, the exploration and elimination of provoking factors are also must be part of the management and the regular follow-up is essential to recognize the disease relapses, thus avoid permanent organ damage.]

AFFILIATIONS

  1. Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Klinikai Immunológiai Tanszék, Belgyógyászati Intézet
  2. MÁV Kórház
  3. Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Gasztroenterológiai Tanszék, Belgyógyászati Intézet

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Anna Tompa MD: Globalization and Health ]

BALÁZS Péter

Lege Artis Medicinae

[Hungarian health care professionals’ attitudes and habits regarding blood donation in different professional groups]

RAJKI Veronika, HIRDI Henriett Éva, BALOGH Zoltán, MÉSZÁROS Judit

[INTRODUCTION - We carried out a survey in Hungary among health care workers, we surveyed their habits in blood donation and their knowledge about the blood donation. METHODS - A cross-sectional study happened between 15th July and 15th Sep-tember in 2012 among the Adult nursing care-, Emergency care-, Surgical care-, and Maternity care professional groups, with convenience sampling statistical method (n=312). The data collection happened with a web-based, anonymous, self-administered questionnaire. For the edited electronic questionnaire we used some question from the “Eurobarometer 41.0 (1995): Europeans and the blood” survey. We analyzed the collected data with IBM SPSS Statistics 20 software and Kingsoft Office Spreadsheet (2012) program, using by descriptive statistical methods. RESULTS - The survey has occured with the participation of 312 health care workers. The blood donation activity of the health care workers in every professional groups was higher than the national average in a EU survey stated in 2009. 61.86% of the health care professionals give blood at least twice a year at different locations. The most common causes of the non-appearance from blood donation were the “other reasons”, “earlier forbidden from blood donation” and “lack of time”. We found differences in their view in each groups about refusing/authorizing blood transfusion, but these have no great importance. CONCLUSION - Regarding to our results we recommend to open the eyes to the need for common, aligned collaboration, and to the modifying the current competencies, to the betterment of the opportunities for further trainings in order to further increase of blood donation habits and attitudes. ]

Lege Artis Medicinae

[Arthur Görgei’s Head Wound ]

ÓCSAI Antal

Lege Artis Medicinae

[Fulvestrant and long progression free survival: a patient with metastatic breast cancer]

BÁNHEGYI Róbert János, LACZÓ Ibolya, FÜLÖP Ferenc, MELLÁR Erzsébet, CSIFFÁRI Margit, PIKÓ Béla

Lege Artis Medicinae

[Parkinson’s disease from the perspective of general practice]

KOVÁCS Norbert

[Due to the recent developments in medicine, Parkinson’s disease became a relatively well-treatable condition. Recently the working abilities and the health-related quality of life of our patients dramatically improved by the application of optimal pharmacological and functional neurosurgical treatment options. Despite of these good progresses, the curative treatment option is still warranted. The aim of this review article is to present those pharmacological, neurosurgical and other treatments, which can improve the condition and quality of life of the patients. We also discuss the major concerns important for general practitioners including the assessment of driving abilities.]

All articles in the issue

Related contents

Journal of Nursing Theory and Practice

[Practice of the Hepatitis B vaccination with non-responder patients in our Centre]

GÓZ Lászlóné, KÖRTVÉLYESINÉ Bari Krisztina, BECS Gergely, SZABÓ P. Réka, BALLA József, KÁRPÁTI István, MÁTYUS János, UJHELYI László, BEN Thomas

[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]

LAM Extra for General Practicioners

[Polyneuropathy as a first sign of microscopic polyangiitis]

ZÖLD Éva, HORVÁTH Ildikó Fanny, TARJÁN Péter, BARTA Zsolt, ZEHER Margit

[INTRODUCTION - Microscopic polyangiitis (MPA) is a systemic autoimmun disease characterized by necrotizing small vasculitis. MPA belongs to the ANCA-associated vasculitides. The disease can affect many of the body’s organ systems. Major organs involved are kidneys, skin, peripheral nerves and lungs. In addition, generalized symptoms such as fever and weight loss are very common. CASE REPORT - In January 2013 a 56-year old woman presented with weight loss, lower leg numbness, walking difficulty and petechiae on the lower legs. One month later, laboratory examinations showed progressive kidney dysfunction, anemia, hypersedimentation and elevated C reactive protein level, but further tests and investigations for potential bacterial infection and tumors were all negative. In sum, clinical signs and symptoms suggested systemic vasculitis, which was proved by the kidney biopsy and ENG examination. From these findings, microscopic polyangiitis was diagnosed with polyneuropathy and glomerulonephritis. The patient was a Hepatitis B (HBV) virus carrier, which can be provoking factor for vasculitis. Corticosteroid and six treatment cycles of intravenous pulse cyclophosphamide were performed for induction of remission. After treatment her symptoms improved and kidney function was normalized. Antiviral treatment was started because of HBV reactivation in October 2013. As a new manifestation of MPA, pulmonary symptoms were appeared in November 2013 and the patient was treated with synchronization of plasmapheresis and pulse cyclophosphamide with good clinical effectivity. Now, she is treated with methotrexate as immunosuppressive treatment and control examinations indicate the remission of the disease with proper renal function. CONCLUSION - We draw attention to a rare case of vasculitis and underline the importance of both the early diagnosis and the early and effective immunosuppressive therapy. Peripheral neuropathy may occur as a result of having systemic vasculitis. Nevertheless, the exploration and elimination of provoking factors are also must be part of the management and the regular follow-up is essential to recognize the disease relapses, thus avoid permanent organ damage.]

Hypertension and nephrology

[Prominents in Hungarian nephrology Professor Gyula Petrányi (1912-2000). Part II]

SZALAY László

[A nation can only survive and keep its identity through its traditions. This is why the initiative to launch this series coming from professor János Radó is worthy of attention. Gyula Petrányi is an outstanding personality in 20th century internal medicine, to be more precise in nephrology and immunology, his activity being wide-ranging. The first part of the current summary of his work deals with a tribute to his personality, and his role in immunomodularity treatment in glomerulonephritis. The second part shall cover his role in spreading renal biopsy, screening and caring kidney patients, dialysis, in developing kidney patients’ care, furthermore in clinicopharmacology and renal transplantation.]

Hypertension and nephrology

[New development in the pathogenesis, diagnosis and treatment of IgA nephropathy]

NAGY Judit, VAS Tibor, KOVÁCS Tibor

[IgA nephropathy is one of the leading cause of primary glomerulonephritis worldwide. IgA nephropathy is regarded as an immune mediated disease with a multi-hit pathogenesis starting with the production of poorly glycosylated IgA1 and glycan-specific IgG and IgA autoantibodies leading to the formation of IgA1 containing immune complexes. These immune complexes deposit in the glomerular mesangium followed by the onset of mesangioproliferative glomerulonephritis. The disease has variable clinical presentation and outcome. There is a need to identify patients who have the potential to progress to end-stage renal disease with the help of clinical, histological and biological markers. Treatment options for IgA nephropathy are largely based on opinion or weak evidence. It is true for the KDIGO Clinical Practice Guideline for Glomerulonephritis treatment recommendations containing low level of evidence for almost all recommendations related to IgA nephropathy. It is suggested to separate the patients into 3 groups on the basis of risk to progression and to give not-specific supportive treatment (especially angiotensin converting enzyme inhibitors or angiotensin receptor blocking agents) to all of them on the basis of the risk factors. We discuss the recommendations of the KDIGO Guideline about steroid and immunosuppressive treatment for moderate and high risk patients. Lastly, we provide our perspective on the existing other treatment options (tonsillectomy etc.) and on ongoing clinical trials.]

Hypertension and nephrology

[Prominents in Hungarian nephrology Professor Gyula Petrányi (1912–2000). I. part]

SZALAY László

[A nation can only survive and keep its identity through its traditions. This is why the initiative to launch this series coming from professor János Radó is worthy of attention. Gyula Petrányi is an outstanding personality in 20th century internal medicine, to be more precise in nephrology and immunology, his activity being wide-ranging. The first part of the current summmary of his work deals with a tribute to his personality, and his role in immunomodularity treatment in glomerulonephritis. The second part shall cover his role in spreading renal biopsy, screening and caring kidney patients, dialysis, in developing kidney patients’ care, furthermore in clinicopharmacology and renal transplantation.]