A 71-year-old Caucasian male was admitted to the outpatient nephrology omegla clinic with the compla

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Abstract Full-Text PDF Full-Text HTML Full-Text ePUB Linked omegla References omegla How to Cite this Article Case Reports omegla in Nephrology Volume 2014 (2014), Article ID 762528, 5 pages http://dx.doi.org/10.1155/2014/762528
Introduction . Liver involvement due to hyperthyroidism and also ANCA positive vasculitis related renal failure cases were reported separately several times before. However, to our knowledge, these two complications together in the same case had never been observed before. Case Presentation . The case of an ANCA positive 71-year-old Caucasian male with renal failure and lung involvement, subclinical hyperthyroidism, and intrahepatic cholestatic jaundice was presented in this paper. After exclusion of all of the other possibilities, cholestatic hepatitis was explained by subclinical hyperthyroidism; renal failure and lung involvement were interpreted as ANCA related vasculitis which might be a side effect omegla of propylthiouracil use. Conclusion . The coexistence of these rare conditions in the same patient deserves emphasis and it is worth reporting. This case demonstrates that following the clinical course of the patient is essential after prescribing any medications to see whether any complication occurs or not. If the complications of this case were noticed earlier, it would be possible to treat and to prevent the permanent damages. 1. Introduction
It omegla was reported previously that at least one hepatic abnormality was observed in 60.5% of the patients with hyperthyroidism because of hypoxia omegla in hepatocytes [ 1 ]. Increased metabolic rate in hyperthyroidism causing extra demand and insufficiency of oxygen demand in hepatocytes was claimed from these abnormalities [ 2 , 3 ].
Propylthiouracil (PTU) is one of the most common drugs to treat hyperthyroidism which is reported to be responsible for ANCA (anti-neutrophil cytoplasmic autoantibody) positivity in 4% to 46% of cases, and even leading to vasculitis especially in China and Japan [ 4 ]. Even though PTU induced ANCA positive vasculitis cases were reported more often in Grave’s disease, it also may be related to multinodular omegla toxic goiter [ 5 ]. PTU-induced ANCA associated systemic vasculitis (AASV) was reported to be involved omegla with the kidneys, omegla skin, and pulmonary system; furthermore, arthralgia and fever were also observed as the most common symptoms [ 6 ]. Kidney involvement was reported to be present from mild to severe degree [ 7 ].
Based on these information, this case was found to be interesting and rare to be presented here. The case was interpreted as intrahepatic cholestasis caused by nodular toxic goitre and the drug which was used to treat hyperthyroidism omegla leading to ANCA related vasculitis and renal failure. 2. Case Presentation
A 71-year-old Caucasian male was admitted to the outpatient nephrology omegla clinic with the complaints of general malaise, progressive asthenia, weight loss, loss of appetite, jaundice, and decrease in urine volume. On admission, blood pressure was 120/70 mm/Hg; the pulse rate was regular omegla 95/min. He was pale, icteric and dehydrated. On physical examination, no abnormalities were found except hepatosplenomegaly and also multiple nodules in his thyroid glands. He had a history omegla of subclinical hyperthyroidism and hypertension for about 30 years and treated with PTU irregularly, carvedilol (12.5 mg/day), and trimetazidine (60 mg/day). The patient was hospitalized for further investigation.
Ultrasonographic examination and magnetic resonance imaging (MRI) of abdomen were performed to exclude extrahepatic cholestasis omegla and showed no clues for malignancies but heterogeneity of liver parenchyma; intra- and extrahepatic bile duct sizes were normal; enlargement of liver (170 mm) and spleen (188 mm) were observed; in addition, portal and splenic vein diameters were increased. Heart failure omegla and the other rare causes of intrahepatic cholestasis were also excluded. Pathological examination of liver biopsy showed that there was sparse piece-meal necrosis and inflammatory cell infiltration in the portal areas. Focal ductuli proliferation, pericentral intracytoplasmic bile pigments, bile plugs, and diffuse focal necrosis were also noted (Figure 1 ). Histopathological findings were interpreted as intrahepatic cholestasis might be related to thyrotoxicosis.
Serological markers, autoantibodies, omegla laboratory findings, and liver biopsy findings helped us to exclude primary biliary