Case 1: A 22-yeaar-old male with headache, confusion and fever A 22-year-old male was admitted to the hospital because of headache, confusion and fever. He had been previously well. At the time of admission, he was on no medications. Initial laboratory test results were notable for: WBC 2,800; Hb: 6.7; Platelets: 64,000; Creatinine: 1.9. The patient was given broad spectrum antibiotics for the treatment of sepsis and/or bacterial meningitis. However, the patient’s mental status worsened, and he became comatose. All cultures were sterile. A ‘shotgun’ diagnostic approach revealed: ANA: 1/2560 (H); DNA: 883 IU/dL. The creatinine continued to rise.
The impression was that of systemic lupus erythematosus complicated by anaemia, thrombocytopenia, nephropathy and CNS disease. ‘Pulse’ steroids were administered for 3 days without subsequent improvement. Intravenous gamma-globulin failed to raise the platelet count. Rheumatology to the rescue!
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Describe the clinical presentation of thrombotic microangiopathy (TMA)
Discuss treatment options of TMA
Review proposed modifications to the classification of lupus nephritis
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