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Case Records of the Massachusetts General Hospital
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Volume 361:179-187 July 9, 2009 Number 2
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Case 21-2009 — A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure
Eric G. Neilson, M.D., and Alton B. Farris, M.D.

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Presentation of Case

Dr. Anna Greka (Renal Unit): A 61-year-old woman was admitted to this hospital because of abdominal pain, weight loss, and an elevated level of serum creatinine. She had been well until 2 months earlier, when burning epigastric pain developed, associated with nausea, vomiting, fatigue, anorexia, and a 10-kg weight loss. The pain was constant, radiated to the throat, and was exacerbated by eating. Emesis was green, with no blood; vomiting initially occurred after eating, and later occurred once each morning. Ten days before admission, daily shaking chills, constipation, mild headache, and difficulty sleeping developed. During the 2 days before admission, . . . [Full Text of this Article]

Differential Diagnosis

Important Features of the Case

Renal Failure and Ocular Inflammation

            Inflammation of the Eyes

            Vasculitis

            Polyarteritis Nodosa

            Tubulointerstitial Nephritis with Uveitis (TINU)

Clinical Diagnosis

Dr. Eric G. Neilson's Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From Vanderbilt University Hospital and the Department of Medicine, Vanderbilt University School of Medicine, Nashville (E.G.N.); and the Department of Pathology, Massachusetts General Hospital, and the Department of Pathology, Harvard Medical School — both in Boston (A.B.F.).



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