CASE
REPORT
Normotensive
scleroderma renal crisis with diffuse alveolar damage
after corticosteroid therapy
Taio Naniwa1 , Shogo Banno1,
Nobuyuki Takahashi1, Shinji Maeda1,
Yoshihito Hayami1 and Ryuzo Ueda1
Full
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Division of Rheumatology,
Department of Internal Medicine and Molecular Science,
Nagoya City University Graduate School of Medical
Sciences, Kawasumi, Mizuho-ku, Nagoya 467-8601,
Japan |
Received: 15 September
2004 Accepted: 24 December 2004
Abstract A 68-year-old woman with systemic sclerosis developed
acute respiratory failure due to diffuse alveolar hemorrhage
and normotensive scleroderma renal crisis (SRC) shortly
after the initiation of corticosteroid therapy. Treatment
with angiotensin-converting enzyme inhibitor and plasmapheresis
had failed in this patient. Autopsy showed diffuse alveolar
damage and thrombotic micro-angiopathy. The sequence of
events in this patient clarifies the pathologic process
of normotensive SRC, and suggests a causative role of
corticosteroid therapy and normotensive SRC.
Key
words Corticosteroid - Diffuse alveolar
damage (DAH) - Scleroderma renal crisis (SRC) - Systemic
sclerosis (SSc) - Thrombotic microangiopathy (TMA)
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