Akihama T

Carbamazepine-Induced Granulomatous Nectrotizing Angiitis with Acute Renal Failure

A 42-year-old male treated with carbamazepine developed a skin eruption in the trunk, followed by acute renal failure. Laboratory data revealed leukocytosis (15,700/mm3) with eosinophilia (37%). A renal biopsy disclosed granulomatous necrotizing angiitis that differed from classic periateritis nodosa and hypersensitivity angiitis. All drugs were discontinued immediately, and there was a gradual improvement of the renal function. A carefully performed provocation test using carbamazepine was positive. We made a diagnosis of carbamazepine-induced granulomatous necrotizing angiitis. Only 6 cases of drug-induced granulomatous angiitis have been reported prior to the present case. Drug-induced granulomatous angiitis is often fatal. The present report suggests the importance of making a diagnosis quickly, and providing adequate treatment in order to prevent a fatal course.

IgM Monoclonal Gammopathy Accompanied by Nodular Glomerulosclerosis, Urine-Concentrating Defect, and Hyporeninemic Hypoaldosteronism

A 54-year-old male had monoclonal IgM-kappa light chains in the serum and free monoclonal kappa light chains in the urine. Renal biopsy revealed nodular glomerulosclerosis associated with the accumulation of kappa light chains. Isolated microscopic hematuria was present for over 1 year. He also showed a defect in urine concentration for which the light chains deposited along the basement membrane in the inner medullary tubules were judged to be responsible. When the glomerular filtration rate fell to 30 ml/min, the syndrome of mild renal failure, decreased potassium excretion, and hyporeninemic hypoaldosteronism developed, suggesting that kappa light chain nephropathy is a cause of this syndrome. Chemotherapy appeared to have some beneficial effects in maintaining renal function.

Antibody-Dependent Cellular Cytotoxicity of Leukemic Cells from the Patients with Acute Myeloid Leukemia to Human Erythrocytes Coated with Anti-D Antiserum

We examined the antibody-dependent cellular cytotoxicity (ADCC) of normal leukocytes from healthy volunteers, immature neutrophils from 4 patients with chronic myelocytic leukemia (CML) and leukemic cells from 22 patients with acute myeloid leukemia, employing human erythrocyte targets. Ability to mediate ADCC was demonstrated only in monocytes among normal leukocytes and in leukemic cells from all the 6 patients with acute myelomonocytic or monocytic leukemia (AMMoL, AMoL). CML immature neutrophils and leukemic cells from 14 patients with acute myeloblastic or promyeloblastic leukemia displayed very low levels of ADCC. In the remaining 2 patients with acute myeloblastic leukemia, the ADCC levels were high. We described the usefulness of this ADCC assay for distinguishing AMMoL or AMoL from other types of acute myeloid leukemia.