[A case report of rheumatoid arthritis which showed acute renal failure, nephrotic syndrome and drug-related lupus-like syndrome caused by D-penicillamine]

Abstract

The patient was a 74 years-old male who had suffered arthralgia since April 1986. Gold therapy was performed from June 1986 based on a diagnosis of rheumatoid arthritis (RA). This treatment was ineffective and administration of D-penicillamine (D-Pc) was started from March 1987, which alleviated the arthralgia. However, proteinuria appeared, and the nephrotic syndrome (NS) and acute renal failure (ARF) gradually developed. Four items, not including the renal symptoms, fulfilled the diagnostic criteria for systemic lupus erythematosus (SLE). Thereafter, D-Pc was withdrawn, and the symptoms were improved by hemodialysis and steroid therapy. This case was considered to be NS and ARF caused by treatment of RA with rather small doses of D-Pc (18.3 g in total), but the involvement of other factors could not be ruled out. Since the four items conforming to the SLE diagnostic criteria were alleviated by steroid therapy, the case was considered to be drug-related lupus-like syndrome. In recent years, D-Pc has frequently been used in the treatment of RA and its effects have been confirmed. However, side effects often appear, and considerable caution is required in the presence of drug-related SLE as well as proteinuria. When drug-related SLE is suspected, withdrawal of the drug concerned and steroid therapy appear to be useful.