Light at the end of the TUNEL: HIV-associated thrombotic microangiopathy

摘要: history of hypertension that might have been identified during his care for the noted infections. The patient’s chief complaints were nausea and vomiting. He had more long-standing symptoms generalized weakness, malaise, chronic headache. disclosed a list current and/or recent medications included rifabutin, ethambutol, clarithromycin, nelfinavir, stavudine, lamivudine, trimethoprimsulfamethoxazole, loratadine, amlodipine. Compliance concern, patient recently initiated selfimposed drug holiday. At presentation, physical examination was noteworthy blood pressure 180/120 mm Hg; heart rate ranging from 84 to 112 beats/min; temperature, 96.9 F. remainder noncontributory. Laboratory values obtained at presentation serum creatinine 9.5 mg/dL; BUN, 86 uric acid, 7.6 CASE PRESENTATION sodium, 135 mEq/L; potassium, 4.7 chloride, 106 A 45-year-old man with HIV infection pretotal CO2, 18 total protein, 6.1 g/dL; albumin, 2.3 sented emergency room local medical center. bilirubin, 0.6 glucose, 104 calcium, 8.2 Complications in past consisted mg/dL. Urinalysis revealed 1 3 protein; microof numerous opportunistic infections including toxoplasmosis, scopic urine sediment showed 6 8 white pneumocystis pneumonia, cytomegalovirus retinitis, cells 4 red cells/high-power field no vertebral osteomyelitis resulting an atypical casts. More quantitative assessment degree proteinmycobacterial organism (M. avium intracellulare), rectal uria not performed. Urine cultures grew organisms. herpes. received multiple combinations anti-retrocomplete count hematocrit 26.3%; hemoviral therapy primary as well therapies globin, 8.8 cell count, 3600/mm, directed specifically various he en75% neutrophils, 14% lymphocytes, 7% monocytes, 3% eosincountered. Other specific details ophils, 1% band forms. platelet 76,000/ such counts, lymphocyte subsets, measurements mm. peripheral smear macrocytosis viremia unavailable. than complications schistocytes. infection, renal Therapy aimed achieving acute control stone underwent successful basket retrieval five years preblood instituted, but viously extraction cataract approximately seven BUN did improve over subsequent two days. Because months prior presentation. issues related recognized insufficiency (serum 2.0 mg/dL) desire exclude treatable causes failure one year plan institution dialysis, biopsy performed declined further workup time. reportedly referred University Washington evaluation. normal time