Hydroxychloroquine-Induced Renal Phospholipidosis: Case Report and Review of Differential Diagnoses
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ABSTRACT:
SUBMITTER: Menke A
PROVIDER: S-EPMC10871737 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundDrug-induced phospholipidosis (DIPL) is an acquired lysosomal storage disorder characterized by the accumulation of lamellar bodies and phospholipids, typically associated with the use of cationic amphiphilic drugs (CADs). Over 200 marketed CADs, including widely prescribed β-blockers, have the potential to induce phospholipid deposition in various organs. In rare cases, DIPL may lead to secondary cardiomyopathy.Case summaryWe report the case of a 70-year-old man with a history of hypertension, permanent atrial fibrillation, and Stanford type B aortic dissection. The patient presented with a 2-week history of worsening dyspnoea. Examination revealed cardiomegaly, elevated B-type natriuretic peptide, and left ventricular dysfunction with an ejection fraction of 24%. Despite intensive medical treatment, the patient developed severe pulmonary congestion and died on Day 35. Post-mortem examination revealed vacuolar degeneration and lamellar body accumulation in the myocardium, consistent with DIPL. The most likely causal agent was bisoprolol, one of the patient's prescribed CADs.DiscussionWhile β-blockers are commonly used for the treatment of hypertension and heart failure, their potential to induce phospholipid deposition in the heart is rare but significant. This case underscores the need for awareness of DIPL as a potential adverse effect, especially in patients receiving CADs.
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Project description:Angiogenesis inhibitors such as tyrosine kinase inhibitors (TKIs) are common therapeutics currently used to treat oncologic disease. Surufatinib is a novel, small-molecule multiple receptor TKI approved by the National Medical Products Administration (NMPA) for the treatment of progressive, advanced, and well-differentiated pancreatic and extrapancreatic neuroendocrine tumours (NETs). Thrombotic microangiopathy (TMA) is a well-documented complication of TKIs targeting the VEGF-A/VEGFR2 signalling pathway. Here, we describe a 43-year-old female patient with biopsy-proven TMA and nephrotic syndrome due to surufatinib treatment for adenoid cystic carcinoma. Histological lesions included glomerular endothelial swelling, widening of subendothelial spaces, mesangiolysis, and double contour, which caused nephrotic proteinuria. Effective management was achieved by drug withdrawal and oral anti-hypertensive regents. The management of surufatinib-related nephrotoxicity without compromising its anticancer effects is challenging. Hypertension and proteinuria must be closely monitored during drug use to reduce or stop the dose in a timely manner before severe nephrotoxicity occurs.
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Project description:BACKGROUND:The purpose of this case report is to increase the awareness of tigecycline-induced pancreatitis specifically in renal transplant patients predisposed to the condition. CASE PRESENTATION:A 48-year-old woman developed a donor-derived infection after kidney transplantation, resulting in a ruptured graft renal artery, followed by peritoneal drainage, blood and urine culture infections. Due to multiple drug resistance Acinetobacter baumannii cultured from the preservation fluid and blood, she was treated with tigecycline at the 8th post-transplant day combined with other antibiotics. After 15 days of tigecycline treatment, she was observed with recurrent fever and abdominal distension with a rise in pancreatic enzymes. CT scans showed acute pancreatitis with grade D on Balthazar score, no necrosis visible without contrast injection. These facts were sufficient to hint that pancreatitis was slowly becoming prominent. After withdrawal of tigecycline, CT scans showed that exudation around the pancreas were relieved, and blood amylase returned to the normal range in a week. CONCLUSIONS:Clinicians should pay attention to clinical signs and symptoms and the level of serum pancreatic enzymes in order to monitor the development of pancreatitis. If necessary, abdominal CT scans should be performed regularly when given tigecycline.
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