D-penicillamine-induced crescentic glomerulonephritis and antimyeloperoxidase antibodies in a patient with scleroderma. Case report and review of the literature

Abstract

Therapeutic use of D-penicillamine has been associated with a range of adverse effects. We present a patient with scleroderma, treated with D-penicillamine for 5 years, who developed severe renal failure due to rapidly progressive glomerulonephritis with both crescents and subepithelial immune deposits on renal biopsy. Serological findings included perinuclear antineutrophil cytoplasmic antibodies and antihistone antibodies. She was treated with cyclophosphamide, prednisone, discontinuation of D-penicillamine, and hemodialysis. Therapy resulted in partial recovery of renal function. The clinical course of our patient is in keeping with D-penicillamine-induced chronic membranous nephropathy, followed by rapidly progressive crescentic glomerulonephritis. We discuss the effects of D-penicillamine in our patient, and review the literature on immune-mediated renal disease associated with the use of this drug.