Advertisment
Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:454

Official publication of the Indian Society of Nephrology
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (916 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
   References
   Article Figures

 Article Access Statistics
    Viewed1046    
    Printed58    
    Emailed0    
    PDF Downloaded78    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTERS TO EDITOR
Year : 2016  |  Volume : 26  |  Issue : 1  |  Page : 61-62
 

Pityriasis rubra pilaris and mesangial proliferative glomerulonephritis in a child: Association or coincidence?


1 Department of Pediatrics, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
2 Department of Pediatrics, NRS Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication30-Dec-2015

Correspondence Address:
S Sarkar
Flat No. B/1, Jibantaru Apartment, North Jagtala, Maheshtala, Kolkata - 700 141, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.165005

Rights and Permissions



How to cite this article:
Sarkar S, Misra S, Nandi M. Pityriasis rubra pilaris and mesangial proliferative glomerulonephritis in a child: Association or coincidence?. Indian J Nephrol 2016;26:61-2

How to cite this URL:
Sarkar S, Misra S, Nandi M. Pityriasis rubra pilaris and mesangial proliferative glomerulonephritis in a child: Association or coincidence?. Indian J Nephrol [serial online] 2016 [cited 2019 Dec 10];26:61-2. Available from: http://www.indianjnephrol.org/text.asp?2016/26/1/61/165005


Sir,

Pityriasis rubra pilaris (PRP) is a group of uncommon, chronic dermatosis of juvenile or adult onset. It presents with scaling (pityriasis), reddish-orange patches (rubra), hyperkeratosis around hair follicle (pilus), and palmoplantar keratoderma. PRP may co-exist with various autoimmune disorders including dermatomyositis, vitiligo, and hypoparathyroidism.[1],[2],[3] Its association with the renal disorder is rare.

A 10-year-old boy presented with hematuria, oliguria, and anasarca for 4 weeks and few episodes of generalized tonic-clonic seizure for 2–3 days. There was no history of sore throat or skin infections prior to this illness. Other past medical history was noncontributory. His weight was 41 kg and height was 138 cm (50th percentile). His blood pressure was 126/80 mmHg. A few scaly, bilateral symmetrical, and nonitchy skin lesions were noted on elbows, knees, hands, and feet [Figure 1]. The investigation revealed 4+ urinary albumin and 18–20 red blood cells/hpf. The 24 h urine albumin was 2114 mg. His serum albumin was 1.8 g/dl and cholesterol was 302 mg/dl. Serum urea and creatinine were 39 mg/dl and 0.6 mg/dl, respectively. Antistreptolysin O titer on repeated occasion was low and C3 was 55.3 mg/dl (normal: 90–180 mg/dl), antinuclear factor was negative, partial thromboplastin, activated partial thromboplastin time was normal. Hepatitis B surface antigen, human immunodeficiency virus (HIV)-1, and HIV-2 were nonreactive. Ultrasonography whole abdomen revealed normal study. Electroencephalography revealed normal sleep records. Renal biopsy revealed an increase in mesangial cellularity and matrix along with fibrous crescents, patent capillary loops and no spikes or duplication in the basement membrane [Figure 2]. Biopsy from the skin lesion established the diagnosis of circumscribed juvenile type of PRP (type 4). His renal disease was treated with oral prednisolone and remission achieved after 2 weeks. The patient is on regular follow-up for last 2 years with no relapse of proteinuria until date. He is now under treatment of dermatologist for PRP.
Figure 1: Typical skin lesions of circumscribed juvenile type of pityriasis rubra pilaris (type 4) on hands, knees, and feet

Click here to view
Figure 2: Features of mesangial proliferative glomerulonephritis

Click here to view


PRP is an uncommon inflammatory and hyperproliferative dermatosis with no sex predilection. Both familial and acquired forms of PRP have been reported. It had a varied clinical progression and showed the varied rate of improvement with treatment. The etiology remains unknown. Emotional stress, microbial pathogens, trauma, Vitamin A deficiency, and light exposure may trigger PRP. Coexistence of PRP with other autoimmune disorders might be due to an abnormal immune response to antigenic triggers or microbial pathogens. Association of PRP with T-helper cell dysfunction has also been reported.[2] Association of renal disorders in case of PRP is extremely rare. An extensive search of literature could reveal only two case reports.[4],[5] Both had membranous nephropathy. Mesangial proliferative glomerulonephritis co-existing with the specific subtype of circumscribed juvenile onset PRP (type 4) is hitherto unreported. It is not known whether there is underlying genetic cause for association of these two disorders or it is just a coincidence. Reporting of more such cases could stimulate future research to find out any association.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Polat M, Lenk N, Ustün H, Oztas P, Artüz F, Alli N. Dermatomyositis with a pityriasis rubra pilaris-like eruption: An uncommon cutaneous manifestation in dermatomyositis. Pediatr Dermatol 2007;24:151-4.  Back to cited text no. 1
    
2.
Magro CM, Crowson AN. The clinical and histomorphological features of pityriasis rubra pilaris. A comparative analysis with psoriasis. J Cutan Pathol 1997;24:416-24.  Back to cited text no. 2
    
3.
Rasi A, Soltani-Arabshahi R, Naraghi ZS. Circumscribed juvenile-onset pityriasis rubra pilaris with hypoparathyroidism and brachyonychia. Cutis 2006;77:218-22.  Back to cited text no. 3
    
4.
Lin CY, Maurice PD, Cross NB. A case of pityriasis rubra pilaris associated with membranous nephropathy. Australas J Dermatol 2013;54:e1-3.  Back to cited text no. 4
    
5.
Ohashi H, Takahashi H, Obara M, Suzuki C, Yamamoto M, Yamamoto H, et al. A case of pityriasis rubra pilaris associated with rapidly progressive finger joint destruction. Nihon Rinsho Meneki Gakkai Kaishi 2004;27:407-13.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 

    

Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07