Unusual cause of recurrent macroscopic hematuria in an adolescent girl: Answers
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CLINICAL QUIZ
Unusual cause of recurrent macroscopic hematuria in an adolescent girl: Answers Abir Boussetta 1,2 & Manel Jellouli 1,2 & Raja Aouaidia 2,3 & Rim Goucha 2,4 & Taher Gargah 1,2 Received: 1 October 2020 / Accepted: 15 October 2020 # IPNA 2020
Keywords Child . Gross hematuria . Granulomatous interstitial nephritis . IgA deposits . Systemic lupus erythematosus . Adenomegaly . Sarcoidosis
Answers
coecal lymphadenopathy with hepatomegaly and splenomegaly. Biopsy of these lymphadenopathies was not possible due to the obesity of our patient. However, because of the endemicity of tuberculosis in our country, the patient received anti-tuberculosis treatment for 6 months with the persistence of intra-abdominal lymphadenopathy and appearance of other adenomegalies. The biopsy of leg lesions and the salivary glands showed noncaseating granulomatous in both cases.
1. Common causes of granulomatous interstitial nephritis (GIN) are as follows: &
& &
Inflammatory/rheumatologic diseases, such as sarcoidosis, tubulointerstitial nephritis with uveitis (TINU), Crohn’s disease, granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA) Infections, such as tuberculosis, fungal, and atypical bacterial GIN induced by drugs.
The diagnosis of sarcoidosis was made based on these arguments: &
2. In our patient, ophthalmologic examination did not show uveitis; anti-neutrophil cytoplasmic antibodies (ANCA) were negative. The patient had no digestive disorder and the ileocolonoscopy with biopsy was normal. Tuberculin skin test (TST) was negative. The QuantiFERON-TB was normal. A CT scan of the neck, chest, abdomen, and pelvis had shown a subpleural nodule of the anterior segment of the left upper lobe, mesenteric, retroperitoneal, and ileo-
&
Pathologic evidence of noncaseating granulomas in kidney, skin, and salivary glands. Exclusion of other diseases with similar findings.
Given the significant obesity of our patient, she was not put on corticosteroids but on azathioprine at a dose of 2 mg/kg/day. 3. Recurrent hematuria can be explained by IgA nephropathy which is most likely secondary to sarcoidosis.
This refers to the article that can be found at https://doi.org/10.1007/ s00467-020-04831-w. * Abir Boussetta [email protected] 1
Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia
2
Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
3
Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
4
NephrologyDepartment, Mongi Slim Hospital, Tunis, Tunisia
Discussion We report an original observation of a case of sarcoidosis revealed by recurrent macroscopic hematuria. Sarcoidosis is a multisystem granulomatous disease characterized by the presence of noncaseating granulomas in multiple organs. The disease is rare in children and its incidence is difficult to assess; a Danish series estimated an incidence of 0.29 per 100,000 children and a French series 0.4–0.8 per 100,000 children [1, 2]. Our patient was initially tre
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