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D-penicillamine therapy associated with rapidly progressive glomerulonephritis
P Macarrón1, J E García Díaz, J A Azofra
1Rheumatology Unit, Hospital Virgen de la Salud, Toledo, Spain.
Summary
D-penicillamine treatment for rheumatoid arthritis can cause severe kidney and lung damage, including rapidly progressive glomerulonephritis and pulmonary hemorrhage. Prompt withdrawal of the drug and methylprednisolone pulse therapy can halt disease progression.
Area of Science:
- Nephrology
- Rheumatology
- Pulmonology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- D-penicillamine is a disease-modifying antirheumatic drug (DMARD) used in RA treatment.
- Drug-induced kidney and lung injury are known but rare complications of D-penicillamine therapy.
Observation:
- A 55-year-old woman with advanced RA developed rapidly progressive glomerulonephritis (RPGN) with epithelial crescents and pulmonary hemorrhage.
- These severe renal and pulmonary manifestations occurred after initiating D-penicillamine treatment.
- The patient's condition significantly worsened, indicating a critical adverse drug reaction.
Findings:
- Discontinuation of D-penicillamine was followed by administration of methylprednisolone pulse therapy.
- This therapeutic intervention successfully halted the progression of both kidney and lung damage.
- The case highlights a severe but potentially reversible D-penicillamine-induced nephropathy and pneumonopathy.
Implications:
- This case underscores the importance of vigilant monitoring for renal and pulmonary toxicity in patients treated with D-penicillamine.
- Early recognition and prompt management, including drug withdrawal and immunosuppression, are crucial for favorable outcomes.
- Further research into the pathogenesis and management strategies for D-penicillamine-induced organ damage is warranted.