Thrombotic Thrombocytopenic Purpura and Systemic Lupus Erythematosus: A Rare and Life-threatening Association

Introduction: The association between thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) is uncommon. Diagnosis is often difficult because of their clinical and biologicalsimilarities. The presence of TTP in SLE worsens the prognosis and causes high mortality in the absence of early therapeutic interventions.Case report: We report the case of a 20 year-old man, admitted with nephrotic range proteinuria, hematuria and rapidly progressive renal failure. He also had anemia, thrombocytopenia and pericardial effusion.The diagnosis of SLE was made based on these clinical findings along with positive antinuclear and anti dsDNA antibodies. Renal biopsy revealed class IV/ V lupus nephritis (LN) with active lesions of thrombotic microangiopathy. The evolution of neurological deficit, persistent thrombocytopenia and active microangiopathic changes suggested the diagnosis of associated TTP. The patient was treated initially with corticosteroids and cyclophosphamide. Plasmapheresis could only be started 16 days later. Mycophenolate mofetil and rituximab weresuccessively tried in the absence of improvement in renal function and persistent thrombocytopenia. The patient’s neurological condition deteriorated necessitating transfer to the intensive care unit and mechanical ventilation. There he developed pneumonia and died of septic shock two months after presentation.Conclusion: The coexistence of TTP and SLE needs to be considered early in SLE patients with complicated course. It may not respond to the conventional immunosuppressive treatment of SLE

Brown tumor of lumber spint in patient with chronic renal failure

Brown tumors are erosive bone lesions caused by increased osteoclastic activity. They usually occur in the severe forms of secondary  hyperparathyroidism, as in patients with hemodialysis-dependent chronic renal disease. Involvement of the lumbar spine with this tumor causing neural compression is extremely rare. We report a 49-year-old man, who had been on haemodialysis for CRF for over 15 years, presented with leg weakness and back pain over the thoracolumbar junction. There were no motor or sensory disturbances. Spinal MRI revealed osteolytic lesions of the ribs and lumbar vertebrae L1. The clinical and radiological abnormalities resolved after parathyroidectomy and spine surgery

The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease

Background: Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD