A rare form of pancreatic diabetes complicated by portal venous thrombosis: A 25-year follow-up

Fibrocalculous pancreatic diabetes (FCPD) is an uncommon type of diabetes mellitus, so called tropical diabetes, due to chronic calcific non-alcoholic pancreatitis. This type of diabetes is associated to several particularities based on glycemic control and the occurrence of degenerative and metabolic complications, in addition to chronic pancreatitis complications such us venous thrombosis. We report here a rare case of a young North-African patient with long standing FCPD followed for 25 years and complicated by portal venous thrombosis. This case presentation highlights how important is to suspect fibrocalculous pancreatic diabetes especially in the presence of chronic abdominal pain. The follow-up of such patients should be focused not only on the clinical and biological markers of diabetes, but also on pancreatitis complications

Benzylthiouracil-Induced Glomerulonephritis

Vasculitis is a rare complication of antithyroid drugs (ATDs). It was first described with Propylthiouracil (PTU). We report a new case of antineutrophil cytoplasmic antibody (ANCA) vasculitis with glomerulonephritis induced by Benzylthiouracile (BTU). A 50-year-old man with Graves disease treated with BTU developed general malaise and haematuria without skin rash or respiratory involvement. Laboratory data revealed acute renal failure with proteinuria and haematuria. An indirect immunofluorescence test for ANCA was positive, showing a perinuclear pattern with specificity antimyeloperoxidase (MPO). A renal biopsy was performed and revealed pauci-immune extracapillary glomerular nephropathy and necrotic vasculitis lesions. Based on these findings we concluded to the diagnosis of rapidly progressive glomerulonephritis associated with ANCA induced by BTU therapy. The drug was therefore discontinued and the patient was treated with steroids and immunosuppressive treatment during 3 months. Renal failure, proteinuria and haematuria significantly improved within 2 months. However, P-ANCA remained positive until 10 months after drug withdrawal. Thyroid function was kept within normal range using iodine solution. We demonstrated clearly that BTU may induce severe forms of vasculitis with glomerulonephritis. Thus, the ANCA must be measured when confronted to systemic manifestation during treatment