Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
A 44-year-old man presented with generalised weakness, shakiness, loss of appetite, fatigue, flank pain and vertigo for several days. He had vomited several times. On examination, he was somnolent, with psychomotor slowing and disorientation, but with no additional focal neurological deficit. Laboratory findings identified acute kidney injury (creatinine 1389 µmol/L, normal<115). Blood gas analysis showed acidosis with pH 7.29 (normal 7.35–7.45), reduced bicarbonate (15 mmol/L; normal 22–26), a negative base excess (−10 mmol/L; normal −2 to 2) and elevated anion gap (28 mmol; normal 3–11). Ultrasound scan of abdomen showed enlarged kidneys. MR scan of brain showed extensive signal changes bilaterally in the basal ganglia and brainstem as well as in temporomesial areas (figure 1A,B). The cerebrospinal fluid (CSF) showed a granulocytic pleocytosis (164 cells/µL; normal <4) with elevated CSF protein (2.3 g/L; normal <0.45). No bacterial or viral pathogen was detected in the PCR multiplex, nor any oxalate crystals or etylene glycol in a later assay. A broad autoimmune …
KA and JGH are joint senior authors.
Contributors All authors were involved in the care of the patient and contributed to the design of the manuscript. TG and JGH wrote the first draft. All authors reviewed the manuscript and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Bimsara Senanayake, Colombo, Sri Lanka.