The author discusses a case of drug induced vasculitis caused by spironolactone which is very rare complication of the drug. The authors give account on the type of vasculitis caused by drug induced allergy and also the differential diagnoses if the presentation is unusual with only hematuria and kidney injury. The benefits of Spironolactone and the side effects are also illustrated.Painful gynecomastia, hyperkalemia, hypomagnesemia, hyponatremia, or hypocalcemia are rare side effects of the

We reported a case of adynamic bone disease (ABD) in an older woman with chronic kidney disease, stage-4 (CKD-4), with an estimate of 29ml/min glomerular filtration rate (eGFR). Similarly, the patient presented with bone pain and osteoporosis as well as intact parathyroid hormone (PTH) was suppressed (<6ng/dl) secondary to the use of vitamin D analogs for secondary hyperparathyroidism (SHPT) of CKD. Furthermore, the hypercalcemia of (11.1 mg/dl), and her dual-energy X-ray absorptiometry (DEXA) scan showed bone mineral density (BMD) of -2.6 SD. Low levels of PTH induces a state of low turnover bone disease. Numerous, factors are involved in this process in patients with ESRD on dialysis. Among these factors are the use of vitamin D analogs, the ill-effects high calcium baths, treatment of osteoporosis with bisphosphonates, etc. All these factors can singly or in combination suppress PTH and render the bone resistant to its action with the end results of a dynamic bone disease. The vitamin D analogs were stopped to allow recovery of the PTH and activation of the osteocytes and osteoblasts. Six months after stopping active vitamin D analogs, her hypercalcemia was resolved, and the PTH increased to 172 ng/dl. Her bone pain has resolved.

We reported a case of severe anemia in a patient with end-stage kidney disease (ESKD) on dialysis. The anemia developed when the patient is switched from hemodialysis (HD) to peritoneal dialysis (PD) when the intra-venous erythropoietin stimulating agent (ESA, Epogen) was changed into subcutaneous injection of darbepoetin. The patient's hemoglobin dropped 2 grams in about two months during this period. Extensive work-up including, bleeding disorders, hemolysis, iron deficiency, infections including CMV, Epstein-Bar virus, parvo-19 virus infection were unrevealing The anti-Epogen neutralizing antibodies were not measured due to unavailability. Bone marrow biopsy and aspirate were negative for infiltrations or myelodysplastic syndrome (MDS). The leukocyte and platelet counts were normal. Even though anti-ESA antibodies were not measured in this case, all tentative causes of his anemia were excluded by laboratory investigations. The patient's anemia was treated symptomatically with blood transfusion and discontinuation of the ESA treatment. He made a remarkable recovery.

The author discusses a case of herpes simplex encephalitis in a young man presented with headache and continuous seizures. The CNS infection with grand-mal seizures resulting in tissue breakdown and complications of acute kidney injury and lactic acidosis. Once the seizures are brought under control the lactic acidosis and the AKI resolved, but the patient tormented from the CNS squeals of HSE in the form of neuropsychiatric complications with long-term effect that necessitate 24-hour care to cope with his daily livings.

The patient is 68 year old white female with a history of type 2 diabetes, hypertension, hyperlipidemia, and congestive heart failure. She is functionally independent. She had chicken-pox as a child but did not received varicella zoster vaccine. In 2014 she had sudden onset of right facial throbbing headache for 2 days. Subsequently, she developed a rash of varicella zoster viral (VZV) infection in the distribution of right ophthalmic branch of the trigeminal nerve. The rash involves the tip of the nose and the patient was complaining of dizziness and impaired vision. She was seen by the ophthalmologist who put her on antiviral medication because of the threat to her vision.Two days after the appearance of the rash she complained of headache and weakness of the left side of the body. Neurological examination at that time revealed evidence of left sided stroke in the distribution of the anterior/middle cerebral arteries. A CT scan followed by MRI of the brain confirmed the presence of stroke in the distribution of the MCA at the grey-white matter junction.A spinal tap along with broader set of diagnostic laboratory tests involving VZV-IgG antibodies, CSF mononuclear pleocytosis, and positive intra-thecal synthesis of VZV-IgG as shown by dissociation of serum to CSF ratio of anti-VZV IgG confirms the diagnosis. Even through, the VZV-DNA was negative. Eventually, a diagnosis of VZVinfection (herpes zoster ophthalmicus with vasculopathy and stroke) was made.Treatment was started with prednisone 60 mg/day and tapered over 2 weeks, gabapentin 200 mg three times daily, and valacyclovir 500 mg Q12 hrs. For 14 days. The patient made a remarkable recovery with resolution of her neurological deficit, and subsidence of and eventually disappearance of the rash of VZV. Luckily, her vision was not impaired. Three months later she was in a good health, very active in her daily livings, and denied post-herpetic neuralgia (PHN). DiscussionThe advent of polymerase chain reaction (PCR) and VZV DNA sequencing along with anti-VZV antibody detection have improved clinical diagnosis of VZV infection. These advances in diagnostic technologies have made identifications of various sequelae of VZV pathology easier. The VZV-vasculopathy including, myelitis, meningoencephalitis, cerebral ataxia, and cranial polyneuritis can be diagnosed with or without VZV-rash [1].