Respir Case Rep. 2019; 8(1): 21-25 | DOI: 10.5505/respircase.2019.14471

Minimal change disease and bilateral non-arteritic ischemic optic neuropathy in a patient with pleural mesothelioma

Senyo Tagboto
Yarmouth Regional Hospital, Yarmouth, Canada; University of Health and Allied Sciences, Ho, Ghana

Malignant mesothelioma typically presents with slowly progressive dyspnea and chest pain. Extra-thoracic symptoms and paraneoplastic presentations are very rare. The association of this malignancy with glomerular disorders has been only rarely reported in the literature. The present report describes the case of a 65-year-old man with a remote occupational exposure to asbestos more than 26 years prior who presented with a month’s history of slowly progressive visual loss, minimal weight loss, and pedal edema. Assessments by several ophthalmologists concluded that he had developed non-arteritic ischemic optic neuropathy. Further nephrological work-up demonstrated that he had developed nephrotic syndrome due to minimal change disease, which was confirmed with a renal biopsy. His clinical symptoms rapidly improved with steroid treatment. The nephrotic syndrome went into clinical remission, his progressive visual loss improved, and there was no further weight loss. The initial chest X-ray performed when he first presented was reported as showing only chronic changes. He reported the symptoms of shortness of breath and chest pain 8 months later and was found to have a large right pleural effusion. Further investigation revealed pleural mesothelioma.

Keywords: Malignant mesothelioma, minimal change disease, nephrotic syndrome, non-arteritic ischaemic optic neuropathy

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Plevral Mezotelyomalý Bir Hastada Bilateral Non-arteritik Ýskemik Optik Nöropati ve Minimal Deðiþiklik Hastalýðý

Senyo Tagboto
Yarmouth Bölge Hastanesi, Yarmouth, Kanada

Malign mezotelyoma tipik olarak yavaþ ilerleyen dispne ve göðüs aðrýsý ile kendini göstermektedir. Toraks dýþý semptomlar ve paraneoplastik tablolar çok nadirdir. Bu maliginite ile glomerüler hastalýk birlikteliði literatürde nadiren bildirilmiþtir. Bu olgu sunumunda, 26 yýl önce mesleksel asbest maruziyeti olan son bir aydýr yavaþ ilerleyen görme kaybý, hafif kilo kaybý ve ayaklarda ödem yakýnmalarý olan 65 yaþýnda erkek hasta sunulmuþtur. Göz hastalýklarý uzmanlarý tarafýndan non-arteritik iskemik optik nöropati geliþtiði belirlendi. Ýleri nefrolojik incelemelerde renal biyopsi ile doðrulanan minimal deðiþiklik hastalýðýna baðlý nefrotik sendrom olduðu gösterildi. Steroid tedavisi ile klinik semptomlar hýzla düzeldi. Nefrotik sendrom ve ilerleyici görme kaybý klinik olarak remisyona girdi ve kilo kaybý düzeldi. Baþlangýç akciðer grafisi yalnýzca kronik deðiþiklikler gösteriyordu. Sekiz ay sonra nefes darlýðý ve göðüs aðrýsý semptomlarý ortaya çýktý ve sað da yoðun plevral sývý saptandý. Ýleri incelemelerde plevral mezotelyoma tespit edildi.

Anahtar Kelimeler: malign mezotelyoma, minimal deðiþiklik hastalýðý, nefrotik sendrom, non-arteritik iskemik optik nöropati

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