PENICILLAMINE-INDUCED RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS IN A PATIENT WITH RHEUMATOID-ARTHRITIS

A 67-year-old woman with rheumatoid arthritis presented rapidly progre ssive glomerulonephritis (RPGN) after 5 months of D-penicillamine (250 mg/day) treatment. Light microscopy study showed severe glomeruloneph ritis with crescent formation in 60% of the glomeruli and infiltration of inflammatory cells in the wall of an arteriole. Immunofluorescence revealed scanty granular IgG, IgA and C3 deposits along the capillary walls and mesangium. The patient was treated with steroid pulse, plas mapheresis, cyclophosphamide and antiplatelet agents. A complete recov ery of renal function was achieved in a few weeks. This new case of RP GN in the course of D-penicillamine treatment emphasizes the need for frequent monitoring of renal function and evaluation of urinary sedime nt and proteinuria in these patients. The prompt discontinuation of D- penicillamine and vigorous treatment measures could allow for a good p rognosis as in this case.