--- a
+++ b/data/text/es-S0211-69952010000400013-1.txt
@@ -0,0 +1,12 @@
+56-year-old woman, diagnosed with pSS 13 years previously. She presented with dry syndrome, asthenia and frequent episodes of polyarthritis. During this time, she followed prolonged treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids. In addition, in recent months, methotrexate had been associated with little improvement in symptoms.
+Three months after starting dental treatment with dental implants, he was admitted with facial oedema, febrile syndrome and decreased diuresis.
+Physical examination revealed deterioration in general condition, blood pressure (BP) of 160/90 mmHg, fever and submandibular oedema with evidence of active infection in the lower dental arch. There was no distal oedema or skin lesions.
+Laboratory tests showed Hb 9.2 g/dl, creatinine 2.9 mg/dl, urea 110 mg/dl, normal liver profile, lipid profile, ANCA and immunoglobulins. ANA positive, anti-DNA negative. Low C3 and C4, 46 and 1.6 mg/dl, respectively. Serology for HBV, HCV and HIV negative. Blood cultures negative. ANA, anti-Ro, anti-LA and rheumatoid factor (RF) antibodies remained positive since the diagnosis of SSp. He had also occasionally presented hypocomplementemia. Urine proteinuria (2 g/l) and microhaematuria were observed. Renal ultrasound was normal. The patient developed an afternoon fever, despite antibiotherapy, and oliguria, and dialysis treatment had to be started.
+Suspecting acute glomerulonephritis (GN), probably postinfectious, given the history of the mandibular infectious process and hypocomplementemia, a renal biopsy was performed with the following results:
+The cylinder for light microscopy contained 8 glomeruli showing diffuse capillary occlusion by thrombi of PAS-positive proteinaceous material. They were accompanied, in some glomeruli, by segmental infiltration of inflammatory cells. The interstitium showed isolated foci of lymphoplasmacytic inflammation and the arteries were unchanged.
+
+Direct immunofluorescence (DIF) showed strong positivity for IgG, IgM, kappa and lambda thrombi, but weaker for C3 and IgA. C1q and fibrinogen were negative. Ultrastructural study was performed at a later stage.
+
+Pathological diagnosis
+Glomeruli with massive intracapillary thrombi of immunoglobulins suspected of cryoglobulinemic glomerulopathy associated with SS.
+