RESUMEN
In an 81-year-old patient with a history of long-standing stable chronic renal failure a diagnosis of multiple myeloma was made. After an initial chemotherapy, a therapy with intravenous pamidronate, 90 mg monthly, was initiated. After four years of well tolerated therapy, pamidronate was stopped and zoledronate, 4 mg intravenously every four weeks, was started. After approximately one year, an elevated plasma creatinine was noted for the'first time, progressing to end stage renal failure within the next months. At admission, besides end-stage renal failure, severe asymptomatic hypocalcemia was noted. Renal biopsy findings included severe tubulointerstitial damage compatible with drug-induced tubular injury. Prerenal and postrenal failure could be excluded as well as myeloma kidney. The diagnosis of zoledronate-associated end-stage renal failure was made and treatment with hemodialysis was started. Hypocalcemia was treated with calcium and vitamin D3 supplements. After two years of follow up, the patient still required hemodialysis.
Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Hipocalcemia/inducido químicamente , Imidazoles/efectos adversos , Fallo Renal Crónico/inducido químicamente , Lesión Renal Aguda/inducido químicamente , Factores de Edad , Anciano , Anciano de 80 o más Años , Biopsia , Conservadores de la Densidad Ósea/administración & dosificación , Calcio/uso terapéutico , Creatinina/sangre , Difosfonatos/administración & dosificación , Difosfonatos/uso terapéutico , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Imidazoles/administración & dosificación , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/patología , Fallo Renal Crónico/terapia , Túbulos Renales/efectos de los fármacos , Túbulos Renales/patología , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Pamidronato , Diálisis Renal , Factores de Riesgo , Suiza , Factores de Tiempo , Vitamina D/uso terapéutico , Ácido ZoledrónicoRESUMEN
HISTORY AND CLINICAL FINDINGS: A 20-year-old patient was hospitalized with persistent high fever after tonsillitis and swelling of the talocalcanean joint. INVESTIGATIONS: The ECG showed a partial right bundle branch block pattern and pathological T inversions on the left precordial leads. Cardiac Troponin I levels were slightly elevated and echocardiography revealed a dyscinetic area at the right ventricular apex. The anti-streptolysin titer was elevated. DIAGNOSIS: Post-streptococcal rheumatic myocarditis. THERAPY AND FOLLOW-UP: Antibiotic therapy for 2 weeks. The patient showed subjective full recovery after 6 weeks. The anti-streptolysin titer further increases. Nuclear spin tomography of the heart reveal postinflammatory alterations at the apex of the right ventricle. CONCLUSION: Rheumatoid fever is a rare diagnosis in developed countries. This case, however, illustrates that the true prevalence of rheumatoid carditis might be underestimated in the presence of only minimal heart-and joint-specific symptoms.