nephrology image
http://www.kidney-international.org & 2007 International Society of Nephrology
Kidney International (2007) 72, 1038; doi:10.1038/sj.ki.5002417
Steroid-induced striae in severe nephrotic syndrome FE Yeo1 and ES Sawyers1 1
National Naval Medical Center, Bethesda, Maryland, USA Correspondence: FE Yeo, National Naval Medical Center, Bethesda, Maryland 20889, USA. E-mail:
[email protected]
Figure 1 | Marked striae distensae with violaceous hues following skin lines parallel to long axis.
Figure 2 | Healed violaceous striae on patient’s back torso, generally following skin lines.
A 23-year-old man presented with diffuse anasarca and 28 g/day proteinuria. Serum creatinine on presentation was 0.6 mg/dl. Renal biopsy revealed focal segmental glomerular sclerosis with glomerular ‘tip lesion’. The patient was treated with oral prednisone 1 mg/kg/day for approximately 2 months without response. His anasarca worsened and severe striae distensae developed. The patient was continued on steroids while sequential trials of immunosuppressants were added. The patient eventually had a temporary response to cellcept (mycophenolate) 2 g/day and cyclosporine 200 mg twice per day, but ultimately could not tolerate the side effects of these medications. Despite the temporary response, the patient
rapidly progressed to end stage renal disease and now requires dialysis. The striae noted in Figures 1 and 2 eventually split open and wept clear fluid for weeks. Several of these striae became infected with methacillin-resistant staphylococcus aureus (MRSA) and pseudomonas species, requiring antibiotics and intensive daily wound care to heal closed. These images serve as a reminder of a severe complication of one of the most commonly used medications in medicine. Disclaimer: The views expressed in this vignette are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.
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Kidney International (2007) 72, 1038
