Hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease in undifferentiated connective tissue disease: A case report
Identifieur interne : 000326 ( Pmc/Corpus ); précédent : 000325; suivant : 000327Hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease in undifferentiated connective tissue disease: A case report
Auteurs : Song-Zhao Wu ; Xiang Liang ; Jian Geng ; Meng-Bi Zhang ; Na Xie ; Xiao-Yan SuSource :
- World Journal of Clinical Cases [ 2307-8960 ] ; 2019.
Abstract
Fabry disease is a kind of lysosomal storage disease resulting from deficient activity of the lysosomal hydrolase alpha-galactosidase A (GLA). A mutation in the
We report the case of a 41-year-old female patient who was diagnosed with undifferentiated connective tissue disease in 2008. Hydroxychloroquine treatment started 2 years ago, and proteinuria and hematuria increased. Renal biopsy demonstrated renal phospholipidosis. Zebra bodies and myelin figures were found by renal electron microscopy and were initially thought to be indicators of Fabry disease. A genetic analysis of the patient and her family members did not reveal mutations in the
This report reveals one of the adverse effects of hydroxychloroquine. We should pay more attention to hydroxychloroquine-induced renal phospholipidosis.
Url:
DOI: 10.12998/wjcc.v7.i24.4377
PubMed: 31911921
PubMed Central: 6940343
Links to Exploration step
PMC:6940343Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease in undifferentiated connective tissue disease: A case report</title><author><name sortKey="Wu, Song Zhao" sort="Wu, Song Zhao" uniqKey="Wu S" first="Song-Zhao" last="Wu">Song-Zhao Wu</name></author><author><name sortKey="Liang, Xiang" sort="Liang, Xiang" uniqKey="Liang X" first="Xiang" last="Liang">Xiang Liang</name></author><author><name sortKey="Geng, Jian" sort="Geng, Jian" uniqKey="Geng J" first="Jian" last="Geng">Jian Geng</name></author><author><name sortKey="Zhang, Meng Bi" sort="Zhang, Meng Bi" uniqKey="Zhang M" first="Meng-Bi" last="Zhang">Meng-Bi Zhang</name></author><author><name sortKey="Xie, Na" sort="Xie, Na" uniqKey="Xie N" first="Na" last="Xie">Na Xie</name></author><author><name sortKey="Su, Xiao Yan" sort="Su, Xiao Yan" uniqKey="Su X" first="Xiao-Yan" last="Su">Xiao-Yan Su</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31911921</idno><idno type="pmc">6940343</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940343</idno><idno type="RBID">PMC:6940343</idno><idno type="doi">10.12998/wjcc.v7.i24.4377</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000326</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000326</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease in undifferentiated connective tissue disease: A case report</title><author><name sortKey="Wu, Song Zhao" sort="Wu, Song Zhao" uniqKey="Wu S" first="Song-Zhao" last="Wu">Song-Zhao Wu</name></author><author><name sortKey="Liang, Xiang" sort="Liang, Xiang" uniqKey="Liang X" first="Xiang" last="Liang">Xiang Liang</name></author><author><name sortKey="Geng, Jian" sort="Geng, Jian" uniqKey="Geng J" first="Jian" last="Geng">Jian Geng</name></author><author><name sortKey="Zhang, Meng Bi" sort="Zhang, Meng Bi" uniqKey="Zhang M" first="Meng-Bi" last="Zhang">Meng-Bi Zhang</name></author><author><name sortKey="Xie, Na" sort="Xie, Na" uniqKey="Xie N" first="Na" last="Xie">Na Xie</name></author><author><name sortKey="Su, Xiao Yan" sort="Su, Xiao Yan" uniqKey="Su X" first="Xiao-Yan" last="Su">Xiao-Yan Su</name></author></analytic><series><title level="j">World Journal of Clinical Cases</title><idno type="eISSN">2307-8960</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND</title><p>Fabry disease is a kind of lysosomal storage disease resulting from deficient activity of the lysosomal hydrolase alpha-galactosidase A (GLA). A mutation in the <italic>GLA</italic> gene leads to a loss of activity of alpha-galactosidase A. Some drugs, such as hydroxychloroquine, can cause pathological changes similar to those usually seen in Fabry disease.</p></sec><sec><title>CASE SUMMARY</title><p>We report the case of a 41-year-old female patient who was diagnosed with undifferentiated connective tissue disease in 2008. Hydroxychloroquine treatment started 2 years ago, and proteinuria and hematuria increased. Renal biopsy demonstrated renal phospholipidosis. Zebra bodies and myelin figures were found by renal electron microscopy and were initially thought to be indicators of Fabry disease. A genetic analysis of the patient and her family members did not reveal mutations in the <italic>GLA</italic> gene, supporting a diagnosis of hydroxychloroquine-induced renal phospholipidosis.</p></sec><sec><title>CONCLUSION</title><p>This report reveals one of the adverse effects of hydroxychloroquine. We should pay more attention to hydroxychloroquine-induced renal phospholipidosis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Alroy, J" uniqKey="Alroy J">J Alroy</name></author><author><name sortKey="Sabnis, S" uniqKey="Sabnis S">S Sabnis</name></author><author><name sortKey="Kopp, Jb" uniqKey="Kopp J">JB Kopp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Waldek, S" uniqKey="Waldek S">S Waldek</name></author><author><name sortKey="Feriozzi, S" uniqKey="Feriozzi S">S Feriozzi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ortiz, A" uniqKey="Ortiz A">A Ortiz</name></author><author><name sortKey="Oliveira, Jp" uniqKey="Oliveira J">JP Oliveira</name></author><author><name sortKey="Wanner, C" uniqKey="Wanner C">C Wanner</name></author><author><name sortKey="Brenner, Bm" uniqKey="Brenner B">BM Brenner</name></author><author><name sortKey="Waldek, S" uniqKey="Waldek S">S Waldek</name></author><author><name sortKey="Warnock, Dg" uniqKey="Warnock D">DG Warnock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilcox, Wr" uniqKey="Wilcox W">WR Wilcox</name></author><author><name sortKey="Oliveira, Jp" uniqKey="Oliveira J">JP Oliveira</name></author><author><name sortKey="Hopkin, Rj" uniqKey="Hopkin R">RJ Hopkin</name></author><author><name sortKey="Ortiz, A" uniqKey="Ortiz A">A Ortiz</name></author><author><name sortKey="Banikazemi, M" uniqKey="Banikazemi M">M Banikazemi</name></author><author><name sortKey="Feldt Rasmussen, U" uniqKey="Feldt Rasmussen U">U Feldt-Rasmussen</name></author><author><name sortKey="Sims, K" uniqKey="Sims K">K Sims</name></author><author><name sortKey="Waldek, S" uniqKey="Waldek S">S Waldek</name></author><author><name sortKey="Pastores, Gm" uniqKey="Pastores G">GM Pastores</name></author><author><name sortKey="Lee, P" uniqKey="Lee P">P Lee</name></author><author><name sortKey="Eng, Cm" uniqKey="Eng C">CM Eng</name></author><author><name sortKey="Marodi, L" uniqKey="Marodi L">L Marodi</name></author><author><name sortKey="Stanford, Ke" uniqKey="Stanford K">KE Stanford</name></author><author><name sortKey="Breunig, F" uniqKey="Breunig F">F Breunig</name></author><author><name sortKey="Wanner, C" uniqKey="Wanner C">C Wanner</name></author><author><name sortKey="Warnock, Dg" uniqKey="Warnock D">DG Warnock</name></author><author><name sortKey="Lemay, Rm" uniqKey="Lemay R">RM Lemay</name></author><author><name sortKey="Germain, Dp" uniqKey="Germain D">DP Germain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Azevedo, Dj" uniqKey="Azevedo D">DJ Azevedo</name></author><author><name sortKey="D Lmeida, Lo" uniqKey="D Lmeida L">LO D’Almeida</name></author><author><name sortKey="Silveira, Ra" uniqKey="Silveira R">RA Silveira</name></author><author><name sortKey="Sachs, K" uniqKey="Sachs K">K Sachs</name></author><author><name sortKey="Alexandrino, M" uniqKey="Alexandrino M">M Alexandrino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fogo, Ab" uniqKey="Fogo A">AB Fogo</name></author><author><name sortKey="Bostad, L" uniqKey="Bostad L">L Bostad</name></author><author><name sortKey="Svarstad, E" uniqKey="Svarstad E">E Svarstad</name></author><author><name sortKey="Cook, Wj" uniqKey="Cook W">WJ Cook</name></author><author><name sortKey="Moll, S" uniqKey="Moll S">S Moll</name></author><author><name sortKey="Barbey, F" uniqKey="Barbey F">F Barbey</name></author><author><name sortKey="Geldenhuys, L" uniqKey="Geldenhuys L">L Geldenhuys</name></author><author><name sortKey="West, M" uniqKey="West M">M West</name></author><author><name sortKey="Ferluga, D" uniqKey="Ferluga D">D Ferluga</name></author><author><name sortKey="Vujkovac, B" uniqKey="Vujkovac B">B Vujkovac</name></author><author><name sortKey="Howie, Aj" uniqKey="Howie A">AJ Howie</name></author><author><name sortKey="Burns, A" uniqKey="Burns A">A Burns</name></author><author><name sortKey="Reeve, R" uniqKey="Reeve R">R Reeve</name></author><author><name sortKey="Waldek, S" uniqKey="Waldek S">S Waldek</name></author><author><name sortKey="Noel, Lh" uniqKey="Noel L">LH Noël</name></author><author><name sortKey="Grunfeld, Jp" uniqKey="Grunfeld J">JP Grünfeld</name></author><author><name sortKey="Valbuena, C" uniqKey="Valbuena C">C Valbuena</name></author><author><name sortKey="Oliveira, Jp" uniqKey="Oliveira J">JP Oliveira</name></author><author><name sortKey="Muller, J" uniqKey="Muller J">J Müller</name></author><author><name sortKey="Breunig, F" uniqKey="Breunig F">F Breunig</name></author><author><name sortKey="Zhang, X" uniqKey="Zhang X">X Zhang</name></author><author><name sortKey="Warnock, Dg" uniqKey="Warnock D">DG Warnock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Albay, D" uniqKey="Albay D">D Albay</name></author><author><name sortKey="Adler, Sg" uniqKey="Adler S">SG Adler</name></author><author><name sortKey="Philipose, J" uniqKey="Philipose J">J Philipose</name></author><author><name sortKey="Calescibetta, Cc" uniqKey="Calescibetta C">CC Calescibetta</name></author><author><name sortKey="Romansky, Sg" uniqKey="Romansky S">SG Romansky</name></author><author><name sortKey="Cohen, Ah" uniqKey="Cohen A">AH Cohen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Muller Hocker, J" uniqKey="Muller Hocker J">J Müller-Höcker</name></author><author><name sortKey="Schmid, H" uniqKey="Schmid H">H Schmid</name></author><author><name sortKey="Weiss, M" uniqKey="Weiss M">M Weiss</name></author><author><name sortKey="Dendorfer, U" uniqKey="Dendorfer U">U Dendorfer</name></author><author><name sortKey="Braun, Gs" uniqKey="Braun G">GS Braun</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bracamonte, Er" uniqKey="Bracamonte E">ER Bracamonte</name></author><author><name sortKey="Kowalewska, J" uniqKey="Kowalewska J">J Kowalewska</name></author><author><name sortKey="Starr, J" uniqKey="Starr J">J Starr</name></author><author><name sortKey="Gitomer, J" uniqKey="Gitomer J">J Gitomer</name></author><author><name sortKey="Alpers, Ce" uniqKey="Alpers C">CE Alpers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woywodt, A" uniqKey="Woywodt A">A Woywodt</name></author><author><name sortKey="Hellweg, S" uniqKey="Hellweg S">S Hellweg</name></author><author><name sortKey="Schwarz, A" uniqKey="Schwarz A">A Schwarz</name></author><author><name sortKey="Schaefer, Rm" uniqKey="Schaefer R">RM Schaefer</name></author><author><name sortKey="Mengel, M" uniqKey="Mengel M">M Mengel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Selvarajah, M" uniqKey="Selvarajah M">M Selvarajah</name></author><author><name sortKey="Nicholls, K" uniqKey="Nicholls K">K Nicholls</name></author><author><name sortKey="Hewitson, Td" uniqKey="Hewitson T">TD Hewitson</name></author><author><name sortKey="Becker, Gj" uniqKey="Becker G">GJ Becker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fredman, P" uniqKey="Fredman P">P Fredman</name></author><author><name sortKey="Klinghardt, Gw" uniqKey="Klinghardt G">GW Klinghardt</name></author><author><name sortKey="Svennerholm, L" uniqKey="Svennerholm L">L Svennerholm</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Costa, Rm" uniqKey="Costa R">RM Costa</name></author><author><name sortKey="Martul, Ev" uniqKey="Martul E">EV Martul</name></author><author><name sortKey="Reboredo, Jm" uniqKey="Reboredo J">JM Reboredo</name></author><author><name sortKey="Cigarran, S" uniqKey="Cigarran S">S Cigarrán</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Menezes Neves, Pdm" uniqKey="De Menezes Neves P">PDM de Menezes Neves</name></author><author><name sortKey="Machado, Jr" uniqKey="Machado J">JR Machado</name></author><author><name sortKey="Cust Dio, Fb" uniqKey="Cust Dio F">FB Custódio</name></author><author><name sortKey="Dos Reis Monteiro, Mlg" uniqKey="Dos Reis Monteiro M">MLG Dos Reis Monteiro</name></author><author><name sortKey="Iwamoto, S" uniqKey="Iwamoto S">S Iwamoto</name></author><author><name sortKey="Freire, M" uniqKey="Freire M">M Freire</name></author><author><name sortKey="Ferreira, Mf" uniqKey="Ferreira M">MF Ferreira</name></author><author><name sortKey="Dos Reis, Ma" uniqKey="Dos Reis M">MA Dos Reis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhao, F" uniqKey="Zhao F">F Zhao</name></author><author><name sortKey="Dou, Y" uniqKey="Dou Y">Y Dou</name></author><author><name sortKey="Liu, D" uniqKey="Liu D">D Liu</name></author><author><name sortKey="Yuan, W" uniqKey="Yuan W">W Yuan</name></author><author><name sortKey="Quan, S" uniqKey="Quan S">S Quan</name></author><author><name sortKey="Wang, X" uniqKey="Wang X">X Wang</name></author><author><name sortKey="Cheng, G" uniqKey="Cheng G">G Cheng</name></author><author><name sortKey="Xiao, J" uniqKey="Xiao J">J Xiao</name></author><author><name sortKey="Zhao, Z" uniqKey="Zhao Z">Z Zhao</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Clin Cases</journal-id><journal-id journal-id-type="publisher-id">WJCC</journal-id><journal-title-group><journal-title>World Journal of Clinical Cases</journal-title></journal-title-group><issn pub-type="epub">2307-8960</issn><publisher><publisher-name>Baishideng Publishing Group Inc</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31911921</article-id><article-id pub-id-type="pmc">6940343</article-id><article-id pub-id-type="other">jWJCC.v7.i24.pg4377</article-id><article-id pub-id-type="doi">10.12998/wjcc.v7.i24.4377</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease in undifferentiated connective tissue disease: A case report</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Song-Zhao</given-names></name><aff>Nephrology Department, Tungwah Hospital of Sun Yat-Sen University, Dongguan 523000, Guangdong Province, China</aff></contrib><contrib contrib-type="author"><name><surname>Liang</surname><given-names>Xiang</given-names></name><aff>Nephrology Department, Tungwah Hospital of Sun Yat-Sen University, Dongguan 523000, Guangdong Province, China</aff></contrib><contrib contrib-type="author"><name><surname>Geng</surname><given-names>Jian</given-names></name><aff>Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, Guangdong Province, China</aff></contrib><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Meng-Bi</given-names></name><aff>Nephrology Department, Tungwah Hospital of Sun Yat-Sen University, Dongguan 523000, Guangdong Province, China</aff></contrib><contrib contrib-type="author"><name><surname>Xie</surname><given-names>Na</given-names></name><aff>Nephrology Department, Tungwah Hospital of Sun Yat-Sen University, Dongguan 523000, Guangdong Province, China</aff></contrib><contrib contrib-type="author"><name><surname>Su</surname><given-names>Xiao-Yan</given-names></name><aff>Nephrology Department, Tungwah Hospital of Sun Yat-Sen University, Dongguan 523000, Guangdong Province, China.<email>suxiaoyan769@hotmail.com</email></aff></contrib></contrib-group><author-notes><fn><p>Author contributions: Wu SZ and Liang X contributed equally to this work; Su XY analyzed the samples pathologically and revised the manuscript; Wu SZ analyzed the samples pathologically and wrote the manuscript; Geng J analyzed the samples pathologically; Liang X provided the clinical information; Zhang MB and Xie N were involved in collecting and analyzing the data; all authors have read and approved the final manuscript.</p><p>Supported by <funding-source>the Dongguan Social Science and Technology Development Project</funding-source>, No. <award-id>2018507150461629</award-id>.</p><p>Corresponding author: Xiao-Yan Su, MD, Chief Doctor, Department Head, Nephrology Department, Tungwah Hospital of Sun Yat-Sen University, No. 1, Dongcheng East Road, Dongcheng District, Dongguan 523000, Guangdong Province, China. <email>suxiaoyan769@hotmail.com</email></p><p>Telephone: +86-13556758929 Fax: +86-769-22471628</p></fn></author-notes><pub-date pub-type="ppub"><day>26</day><month>12</month><year>2019</year></pub-date><pub-date pub-type="epub"><day>26</day><month>12</month><year>2019</year></pub-date><volume>7</volume><issue>24</issue><fpage>4377</fpage><lpage>4383</lpage><history><date date-type="received"><day>4</day><month>9</month><year>2019</year></date><date date-type="rev-recd"><day>8</day><month>11</month><year>2019</year></date><date date-type="accepted"><day>23</day><month>11</month><year>2019</year></date></history><permissions><copyright-statement>©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.</copyright-statement><copyright-year>2019</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.</license-p></license></permissions><abstract><sec><title>BACKGROUND</title><p>Fabry disease is a kind of lysosomal storage disease resulting from deficient activity of the lysosomal hydrolase alpha-galactosidase A (GLA). A mutation in the <italic>GLA</italic> gene leads to a loss of activity of alpha-galactosidase A. Some drugs, such as hydroxychloroquine, can cause pathological changes similar to those usually seen in Fabry disease.</p></sec><sec><title>CASE SUMMARY</title><p>We report the case of a 41-year-old female patient who was diagnosed with undifferentiated connective tissue disease in 2008. Hydroxychloroquine treatment started 2 years ago, and proteinuria and hematuria increased. Renal biopsy demonstrated renal phospholipidosis. Zebra bodies and myelin figures were found by renal electron microscopy and were initially thought to be indicators of Fabry disease. A genetic analysis of the patient and her family members did not reveal mutations in the <italic>GLA</italic> gene, supporting a diagnosis of hydroxychloroquine-induced renal phospholipidosis.</p></sec><sec><title>CONCLUSION</title><p>This report reveals one of the adverse effects of hydroxychloroquine. We should pay more attention to hydroxychloroquine-induced renal phospholipidosis.</p></sec></abstract><kwd-group><kwd>Fabry disease</kwd><kwd>Undifferentiated connective tissue disease</kwd><kwd>Hydroxychloroquine</kwd><kwd>Renal phospholipidosis</kwd><kwd>Case report</kwd></kwd-group></article-meta></front><body><p><bold>Core tip:</bold> Hydroxychloroquine-induced renal phospholipidosis is characterised by zebra bodies and myelin figures, mimicking nephropathy of Fabry disease. It reminds that clinical application of hydroxychloroquine should be careful. Moreover, drug-induced renal phospholipidosis should be considered as a differential diagnosis, especially when zebra bodies and myelin figures are found in the kidney.</p><sec><title>INTRODUCTION</title><p>Fabry disease is a genetically X chromosome linked disease that can affect many human organs, including the kidneys, heart, and skin[<xref rid="B1" ref-type="bibr">1</xref>-<xref rid="B4" ref-type="bibr">4</xref>]. Furthermore, Fabry disease is a kind of lysosomal storage disease[<xref rid="B5" ref-type="bibr">5</xref>]. In Fabry disease, deficient activity of the lysosomal hydrolase alpha-galactosidase A (GLA) is caused by a mutation in the <italic>GLA</italic> gene, resulting in the intracellular accumulation of enzyme substrates inside of lysosomes[<xref rid="B1" ref-type="bibr">1</xref>-<xref rid="B4" ref-type="bibr">4</xref>].</p><p>The symptoms of Fabry disease affect multiple systems and organs[<xref rid="B1" ref-type="bibr">1</xref>-<xref rid="B4" ref-type="bibr">4</xref>]. Early symptoms arise in the nervous system and are characterized by paresthesia and pain. Symptoms in the skin and eyes appear afterwards and include fever, angiokeratomas, and cornea verticillate. Kidney and heart dysfunction are the main symptoms in adults. Heart dysfunction includes cardiac hypertrophy, valvular abnormalities, and arrhythmias. Renal dysfunction usually includes hematuria, proteinuria, and nephrotic syndrome. In addition, such conditions in the kidney ultimately progress to end-stage kidney disease accompanied by various severe complications. Severe complications are ultimately the primary cause of death. A light microscopic examination of the kidney demonstrates that glomerular visceral epithelial cells are diffusely enlarged with vacuolar degeneration. Electron microscopy examination shows that all kinds of renal cells contain many dense lamellated structures, including glomerular visceral epithelial cells, endothelial cells, and mesangial cells. Such structures are widely called zebra bodies or myelin figures and are the typical characteristics of Fabry disease[<xref rid="B6" ref-type="bibr">6</xref>].</p><p>Zebra bodies or myelin figures were previously seen as the prime characteristics of Fabry disease. However, previous reports showed that some drugs, including amiodarone, chloroquine, and hydroxychloroquine, may lead to similar histological changes[<xref rid="B7" ref-type="bibr">7</xref>-<xref rid="B10" ref-type="bibr">10</xref>]. Here, we report the case of a 41-year-old female patient who was diagnosed with undifferentiated connective tissue disease in 2008. This patient had been on hydroxychloroquine therapy for two years until now. Renal biopsy revealed zebra bodies and myelin figures mimicking Fabry disease. However, the clinical symptoms of Fabry disease, a family history of Fabry disease, and a genetic evaluation of the <italic>GLA</italic> gene were negative.</p></sec><sec><title>CASE PRESENTATION</title><sec><title>Chief complaints and history of present illness</title><p>A 41-year-old female patient was diagnosed with undifferentiated connective tissue disease in 2008. Since then, this patient received low doses of prednisone (Table <xref rid="T1" ref-type="table">1</xref>). Because of facial erythema and a decrease in blood complement in 2016, hydroxychloroquine was added to 400 mg/d, and the dosage of prednisone was increased to 10 mg/d (Table <xref rid="T1" ref-type="table">1</xref>). This patient had a loss of weight of approximately 3 kg by March 2018, as well as proteinuria and weakness. The patient was admitted to our hospital in April 2018.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>The timeline of treatment</p></caption><table frame="hsides" rules="groups"><thead align="center"><tr><td align="left" rowspan="1" colspan="1"><bold>Time</bold></td><td rowspan="1" colspan="1"><bold>Symptoms</bold></td><td rowspan="1" colspan="1"><bold>Diagnoses</bold></td><td rowspan="1" colspan="1"><bold>Treatments</bold></td></tr></thead><tbody align="center"><tr><td rowspan="5" align="left" colspan="1">2008</td><td rowspan="1" colspan="1">Canker sores</td><td rowspan="5" colspan="1">Undifferentiated connective tissue disease</td><td rowspan="5" colspan="1">Low doses of prednisone: 5 mg</td></tr><tr><td rowspan="1" colspan="1">White blood cell count: 1.8 × 10<sup>9</sup>/L</td></tr><tr><td rowspan="1" colspan="1">ANA: 1:320(+)</td></tr><tr><td rowspan="1" colspan="1">Blood complements: Normal</td></tr><tr><td rowspan="1" colspan="1">Serum creatinine: 66 µmol/L</td></tr><tr><td rowspan="2" align="left" colspan="1">2016</td><td rowspan="1" colspan="1">Facial erythema</td><td rowspan="2" colspan="1">Undifferentiated connective tissue disease</td><td rowspan="2" colspan="1">Hydroxychloroquine; Prednisone</td></tr><tr><td rowspan="1" colspan="1">Decreased blood complements</td></tr><tr><td rowspan="11" align="left" colspan="1">April 2018</td><td rowspan="1" colspan="1">Weight loss</td><td rowspan="11" colspan="1">Undifferentiated connective tissue disease; Hydroxychloroquine -induced renal phospholipidosis</td><td rowspan="11" colspan="1">Withdrawal of hydroxychloroquine; Prednisone</td></tr><tr><td rowspan="1" colspan="1">Weakness</td></tr><tr><td rowspan="1" colspan="1">White blood count: 2.7-4.7 × 10<sup>9</sup>/L</td></tr><tr><td rowspan="1" colspan="1">Urine erythrocytes: 28/µL</td></tr><tr><td rowspan="1" colspan="1">Serum creatinine: 58 µmol/L</td></tr><tr><td rowspan="1" colspan="1">24-h urinary protein, quantitative: 1120 mg</td></tr><tr><td rowspan="1" colspan="1">ANA: 1:80(+)</td></tr><tr><td rowspan="1" colspan="1">Complement C3: 0.58 g/L</td></tr><tr><td rowspan="1" colspan="1">Complement C4: 0.09 g/L</td></tr><tr><td rowspan="1" colspan="1">Renal biopsy: Renal phospholipidosis</td></tr><tr><td rowspan="1" colspan="1">Mutation of <italic>GLA</italic> gene: Negative</td></tr></tbody></table><table-wrap-foot><fn><p>ANA: Antinuclear antibody.</p></fn></table-wrap-foot></table-wrap></sec><sec><title>Personal and family history</title><p>The patient had a history of hypertension. There was no relevant family history.</p></sec><sec><title>Physical examination</title><p>There were a few of ulcers in the mouth.</p></sec><sec><title>Laboratory examinations</title><p>The results of laboratory examinations are as follows: White blood cell count, 4.7 × 10<sup>9</sup>/L; 24-h urine protein, 1120 mg and urine red blood cells, 28/µL; routine fecal tests and occult blood test, normal; blood albumin (ALB), 33.40 g/L; serum creatinine, 58 µmol/L; positive antinuclear antibody (ANA), 1/80+; anti-histone antibody, +/-; anti-nucleosome antibody, +/-; negative anti-dsDNA antibody, ANA and anti-GBM antibody; complement C3, 0.58 g/L; complement C4, 0.09 g/L (Table <xref rid="T1" ref-type="table">1</xref>); erythrocyte sedimentation rate and C-reactive protein, normal.</p></sec><sec><title>Imaging examinations</title><p>Color Doppler ultrasound of the kidneys indicated a right renal nodule.</p></sec><sec><title>Pathological examination of the kidney</title><p>Renal biopsy was performed to evaluate nephropathy. A light microscopic examination (Figure <xref ref-type="fig" rid="F1">1</xref>) of paraffin-embedded sections stained with hematoxylin and eosin, periodic acid–Schiff, and Masson’s trichrome showed that glomerular visceral epithelial cells were diffusely enlarged with vacuolar degeneration, but segmental sclerosis and crescents were not observed in glomeruli. The mesangial matrix and cellularity were normal. Renal tubular epithelial cells presented granular degeneration without obvious atrophy. An infiltration of several inflammatory cells could be seen in the renal mesenchyme, but fibrosis was hardly found. Arterioles appeared to be thickened and narrow.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Light microscopic images. Diffuse enlargement and vacuolar degeneration of glomerular visceral epithelial cells are seen. A: Hematoxylin-eosin staining; B: Periodic acid-Schiff staining; C: Periodic acid-silver methenamine staining; and D: Masson staining.</p></caption><graphic xlink:href="WJCC-7-4377-g001"></graphic></fig><p>Immunofluorescence analysis revealed mild staining for IgM. Immunostaining for IgA; IgG; ALB; complement factors C3, C4, and C1q; and fibrinogen was negative.</p><p>Electron microscopic analysis with toluidine blue staining showed (Figure <xref ref-type="fig" rid="F2">2</xref>) that glomerular visceral epithelial cells were swollen. Many vacuoles with dense lamellated structures were present in the cytoplasm of podocytes. A number of secondary lysosomes and foot process fusion could be seen in the cytoplasm of podocytes. Arterioles, mesangial matrix and cellularity were normal. Renal tubular epithelial cells manifested vacuolar degeneration. Some inflammatory cells had infiltrated the renal mesenchyme.</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>Electron microscopic images. Vacuoles with dense lamellated structures are seen in glomerular visceral epithelial cells. Such structures are called zebra and myeloid bodies. Podocyte foot processes appear to be effaced (image B is an enlargement of the part of image A within the white box). Image magnifications are specified at the bottom of each micrograph.</p></caption><graphic xlink:href="WJCC-7-4377-g002"></graphic></fig><p>In conclusion, the renal biopsy demonstrated glomerular visceral epithelial cells containing zebra bodies and myelin figures.</p></sec><sec><title>Genetic testing</title><p>A genetic evaluation of the patient and her family members was performed, and mutations of the <italic>GLA</italic> gene were not detected.</p></sec></sec><sec><title>FINAL DIAGNOSIS</title><p>Hydroxychloroquine-induced renal phospholipidosis.</p></sec><sec><title>TREATMENT</title><p>Withdrawal of hydroxychloroquine.</p></sec><sec><title>OUTCOME AND FOLLOW-UP</title><p>The patient had returned to her native place, and we keep in touch with her. The patient went to the local hospital for examination in April 2019, and urine tests showed that hematuria and proteinuria decreased. Although the patient had already decided not to repeat renal biopsy, we will continue to monitor the conditions of this patient.</p></sec><sec><title>DISCUSSION</title><p>Fabry disease is a rare X-linked genetic disease that can affect many human organs, including the kidney, heart, and skin[<xref rid="B1" ref-type="bibr">1</xref>-<xref rid="B4" ref-type="bibr">4</xref>]. Fabry disease is a kind of lysosomal storage disease[<xref rid="B5" ref-type="bibr">5</xref>]. A mutation in the <italic>GLA</italic> gene in Fabry disease leads to deficient activity of GLA, resulting in the accumulation of multiple hydrolase substrates inside of lysosomes, such as globotriaosylceramide and glycosphingolipids. Fabry disease affects multiple systems and organs, including the nervous system, skin, eyes, kidneys, and heart. The clinical manifestations of multiple systems and organs caused by Fabry disease are various and include paresthesia, fever, angiokeratomas, cornea verticillate, cardiovascular events, hematuria, proteinuria, and nephrotic syndrome. Zebra bodies or myelin figures detected by electron microscopy are typical characteristics of Fabry disease[<xref rid="B6" ref-type="bibr">6</xref>].</p><p>Zebra bodies and myelin figures are prime pathological changes of microscopic tests in Fabry disease, and some studies have shown that similar pathological changes can be caused by some drugs, such as amiodarone, chloroquine, and hydroxychloroquine[<xref rid="B1" ref-type="bibr">1</xref>,<xref rid="B7" ref-type="bibr">7</xref>-<xref rid="B10" ref-type="bibr">10</xref>]. Because of the amphiphilic nature of such drugs, similar pathological changes can be easily seen in various organs, such as the liver, lung, and kidney[<xref rid="B7" ref-type="bibr">7</xref>-<xref rid="B11" ref-type="bibr">11</xref>]. Some lysosomal enzymes, including GLA, can be suppressed by such drugs and lose their biological activity, resulting in a deposition of enzyme substrates inside of lysosomes[<xref rid="B12" ref-type="bibr">12</xref>]. Such enzyme substrates also include globotriaosylceramide and glycosphingolipid[<xref rid="B1" ref-type="bibr">1</xref>]. The deposition of enzyme substrates caused by such drugs in the kidney is usually known as renal phospholipidosis, which is characterized by zebra bodies or myelin figures[<xref rid="B9" ref-type="bibr">9</xref>]. Thus, renal phospholipidosis mimicking Fabry disease may be closely related to the toxicity of some drugs.</p><p>Phospholipidosis caused by drugs usually exhibits intracellular deposition of phospholipids and lamellar bodies, which are often regarded as the primary microscopic markers of lipid storage diseases. Lysosomes are a type of cellular organelle, and they contain all kinds of hydrolytic enzymes, including lipases, phospholipases, and proteases. The deposition of lipids in drug-induced phospholipidosis can be easily found in lysosomes. Hydroxychloroquine is capable of passing through the lysosomal membrane due to its particular chemical structure. Hydroxyhloroquine is able to maintain its structural integrity when it passes through the lysosomal membrane. With the continuous accumulation of hydroxychloroquine inside of lysosomes, some hydrolytic enzymes, including GLA, are suppressed and lose their biological activity. After that, the catabolic processes of numerous enzymatic substrates are blocked, which leads to the deposition of phospholipids and lamellar bodies[<xref rid="B7" ref-type="bibr">7</xref>-<xref rid="B9" ref-type="bibr">9</xref>]. Deposition of the substrates in the kidney leads to renal dysfunction, such as glomerulosclerosis, thickening of glomerular basement membrane, and increase of mesangial matrix. All of these renal pathological changes ultimately cause proteinuria and hematuria. Such characteristics are similar to those of Fabry disease. Therefore, renal phospholipidosis has a close relationship with hydroxychloroquine as well as similar chemical structures[<xref rid="B7" ref-type="bibr">7</xref>-<xref rid="B9" ref-type="bibr">9</xref>].</p><p>Previous studies have reported that some patients who were diagnosed with systemic lupus erythematosus or Sjogren’s syndrome were treated with hydroxychloroquine. After long-term treatment with hydroxychloroquine, renal phospholipidosis was detected by renal microscopic examination. Zebra bodies and myelin figures were found by electron microscopy and were similar to those found in nephropathy of Fabry disease. However, drug-induced renal phospholipidosis was ultimately confirmed based on the manifestations; the activity level of GLA; and the evaluation of the <italic>GLA</italic> gene, family history, and medication history[<xref rid="B8" ref-type="bibr">8</xref>,<xref rid="B13" ref-type="bibr">13</xref>,<xref rid="B14" ref-type="bibr">14</xref>]. A consensus regarding how to make a precise diagnosis of drug-induced renal phospholipidosis has not been established until now. Thus, when some findings resembling Fabry disease are detected during microscopic examination, drug-induced renal phospholipidosis should always be considered as a differential diagnosis, particularly in cases with no family history or relevant symptoms. Accordingly, in this case, a two-year treatment with hydroxychloroquine, an absence of symptoms of Fabry disease, a negative family history of Fabry disease, and an absence of mutations in the <italic>GLA</italic> gene largely pointed to a diagnosis of hydroxychloroquine-induced renal phospholipidosis.</p><p>Early diagnosis is widely acknowledged as an effective treatment for renal phospholipidosis caused by drugs[<xref rid="B15" ref-type="bibr">15</xref>]. In this case, hydroxychloroquine was withdrawn when the diagnosis of hydroxychloroquine-induced renal phospholipidosis was confirmed. Although the patient had returned to her native place, we keep in touch with her. The patient went to the local hospital for examination in April 2019, and urine tests showed that hematuria and proteinuria decreased. Even though the patient had already decided not to repeat renal biopsy, we will continue to monitor the conditions of this patient.</p></sec><sec><title>CONCLUSION</title><p>We have reported a case of hydroxychloroquine-induced renal phospholipidosis. Deposition of phospholipids caused by hydroxychloroquine in the kidney is characterized by zebra bodies and myelin figures similar to nephropathy of Fabry disease. Such pathological changes in the kidney gradually result in glomerulosclerosis, thickening of glomerular basement membrane, and increase of mesangial matrix. Finally, proteinuria or hematuria also appears as the first symptoms. Overall, our presentation provides further evidence of the side effects of hydroxychloroquine. It demonstrates that we should pay more attention to application of hydroxychloroquine. Furthermore, drug-induced renal phospholipidosis should be considered as a differential diagnosis, especially when zebra bodies and myelin figures are found in the kidney.</p></sec><sec><title>ACKNOWLEDGEMENTS</title><p>We would like to thank all members of our department for their helpful comments and general support. We would also like to thank Jian Geng for pathological and genetic evaluations.</p></sec></body><back><fn-group><fn><p>Informed consent statement: Consent was obtained from the patient for publication of this report.</p></fn><fn fn-type="COI-statement"><p>Conflict-of-interest statement: The authors declare that they have no competing interests.</p></fn><fn><p>CARE Checklist (2016) statement: The guidelines of the CARE Checklist have been adopted.</p></fn><fn><p>Manuscript source: Unsolicited manuscript</p></fn><fn><p>Peer-review started: September 4, 2019</p></fn><fn><p>First decision: September 23, 2019</p></fn><fn><p>Article in press: November 23, 2019</p></fn><fn><p>Specialty type: Medicine, research and experimental</p></fn><fn><p>Country of origin: China</p></fn><fn><p>Peer-review report classification</p></fn><fn><p>Grade A (Excellent): 0</p></fn><fn><p>Grade B (Very good): 0</p></fn><fn><p>Grade C (Good): C</p></fn><fn><p>Grade D (Fair): 0</p></fn><fn><p>Grade E (Poor): 0</p></fn><fn><p>P-Reviewer: Galvañ VG S-Editor: Gong ZM L-Editor: Wang TQ E-Editor: Liu JH</p></fn></fn-group><ref-list><ref id="B1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Alroy</surname><given-names>J</given-names></name><name><surname>Sabnis</surname><given-names>S</given-names></name><name><surname>Kopp</surname><given-names>JB</given-names></name></person-group><article-title>Renal pathology in Fabry disease</article-title><source>J Am Soc Nephrol</source><year>2002</year><volume>13 Suppl 2</volume><fpage>S134</fpage><lpage>S138</lpage><pub-id pub-id-type="pmid">12068025</pub-id></element-citation></ref><ref id="B2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Waldek</surname><given-names>S</given-names></name><name><surname>Feriozzi</surname><given-names>S</given-names></name></person-group><article-title>Fabry nephropathy: a review - how can we optimize the management of Fabry nephropathy?</article-title><source>BMC Nephrol</source><year>2014</year><volume>15</volume><fpage>72</fpage><pub-id pub-id-type="pmid">24886109</pub-id></element-citation></ref><ref id="B3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ortiz</surname><given-names>A</given-names></name><name><surname>Oliveira</surname><given-names>JP</given-names></name><name><surname>Wanner</surname><given-names>C</given-names></name><name><surname>Brenner</surname><given-names>BM</given-names></name><name><surname>Waldek</surname><given-names>S</given-names></name><name><surname>Warnock</surname><given-names>DG</given-names></name></person-group><article-title>Recommendations and guidelines for the diagnosis and treatment of Fabry nephropathy in adults</article-title><source>Nat Clin Pract Nephrol</source><year>2008</year><volume>4</volume><fpage>327</fpage><lpage>336</lpage><pub-id pub-id-type="pmid">18431378</pub-id></element-citation></ref><ref id="B4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wilcox</surname><given-names>WR</given-names></name><name><surname>Oliveira</surname><given-names>JP</given-names></name><name><surname>Hopkin</surname><given-names>RJ</given-names></name><name><surname>Ortiz</surname><given-names>A</given-names></name><name><surname>Banikazemi</surname><given-names>M</given-names></name><name><surname>Feldt-Rasmussen</surname><given-names>U</given-names></name><name><surname>Sims</surname><given-names>K</given-names></name><name><surname>Waldek</surname><given-names>S</given-names></name><name><surname>Pastores</surname><given-names>GM</given-names></name><name><surname>Lee</surname><given-names>P</given-names></name><name><surname>Eng</surname><given-names>CM</given-names></name><name><surname>Marodi</surname><given-names>L</given-names></name><name><surname>Stanford</surname><given-names>KE</given-names></name><name><surname>Breunig</surname><given-names>F</given-names></name><name><surname>Wanner</surname><given-names>C</given-names></name><name><surname>Warnock</surname><given-names>DG</given-names></name><name><surname>Lemay</surname><given-names>RM</given-names></name><name><surname>Germain</surname><given-names>DP</given-names></name></person-group><collab>Fabry Registry</collab><article-title>Females with Fabry disease frequently have major organ involvement: lessons from the Fabry Registry</article-title><source>Mol Genet Metab</source><year>2008</year><volume>93</volume><fpage>112</fpage><lpage>128</lpage><pub-id pub-id-type="pmid">18037317</pub-id></element-citation></ref><ref id="B5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Azevedo</surname><given-names>DJ</given-names></name><name><surname>D’Almeida</surname><given-names>LO</given-names></name><name><surname>Silveira</surname><given-names>RA</given-names></name><name><surname>Sachs</surname><given-names>K</given-names></name><name><surname>Alexandrino</surname><given-names>M</given-names></name></person-group><article-title>Primeiros pacientes do Estado do Rio de Janeiro tratados com a enzima recombinante Agalsidase Beta (Fabrazime)/Fabryïs disease: First patients of the state of fio treated with agalsidase beta</article-title><source>Rev Bras Oftal</source><year>2004</year><volume>63</volume><fpage>259</fpage><lpage>263</lpage></element-citation></ref><ref id="B6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fogo</surname><given-names>AB</given-names></name><name><surname>Bostad</surname><given-names>L</given-names></name><name><surname>Svarstad</surname><given-names>E</given-names></name><name><surname>Cook</surname><given-names>WJ</given-names></name><name><surname>Moll</surname><given-names>S</given-names></name><name><surname>Barbey</surname><given-names>F</given-names></name><name><surname>Geldenhuys</surname><given-names>L</given-names></name><name><surname>West</surname><given-names>M</given-names></name><name><surname>Ferluga</surname><given-names>D</given-names></name><name><surname>Vujkovac</surname><given-names>B</given-names></name><name><surname>Howie</surname><given-names>AJ</given-names></name><name><surname>Burns</surname><given-names>A</given-names></name><name><surname>Reeve</surname><given-names>R</given-names></name><name><surname>Waldek</surname><given-names>S</given-names></name><name><surname>Noël</surname><given-names>LH</given-names></name><name><surname>Grünfeld</surname><given-names>JP</given-names></name><name><surname>Valbuena</surname><given-names>C</given-names></name><name><surname>Oliveira</surname><given-names>JP</given-names></name><name><surname>Müller</surname><given-names>J</given-names></name><name><surname>Breunig</surname><given-names>F</given-names></name><name><surname>Zhang</surname><given-names>X</given-names></name><name><surname>Warnock</surname><given-names>DG</given-names></name></person-group><collab>all members of the International Study Group of Fabry Nephropathy (ISGFN)</collab><article-title>Scoring system for renal pathology in Fabry disease: report of the International Study Group of Fabry Nephropathy (ISGFN)</article-title><source>Nephrol Dial Transplant</source><year>2010</year><volume>25</volume><fpage>2168</fpage><lpage>2177</lpage><pub-id pub-id-type="pmid">19833663</pub-id></element-citation></ref><ref id="B7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Albay</surname><given-names>D</given-names></name><name><surname>Adler</surname><given-names>SG</given-names></name><name><surname>Philipose</surname><given-names>J</given-names></name><name><surname>Calescibetta</surname><given-names>CC</given-names></name><name><surname>Romansky</surname><given-names>SG</given-names></name><name><surname>Cohen</surname><given-names>AH</given-names></name></person-group><article-title>Chloroquine-induced lipidosis mimicking Fabry disease</article-title><source>Mod Pathol</source><year>2005</year><volume>18</volume><fpage>733</fpage><lpage>738</lpage><pub-id pub-id-type="pmid">15605079</pub-id></element-citation></ref><ref id="B8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Müller-Höcker</surname><given-names>J</given-names></name><name><surname>Schmid</surname><given-names>H</given-names></name><name><surname>Weiss</surname><given-names>M</given-names></name><name><surname>Dendorfer</surname><given-names>U</given-names></name><name><surname>Braun</surname><given-names>GS</given-names></name></person-group><article-title>Chloroquine-induced phospholipidosis of the kidney mimicking Fabry's disease: case report and review of the literature</article-title><source>Hum Pathol</source><year>2003</year><volume>34</volume><fpage>285</fpage><lpage>289</lpage><pub-id pub-id-type="pmid">12673565</pub-id></element-citation></ref><ref id="B9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bracamonte</surname><given-names>ER</given-names></name><name><surname>Kowalewska</surname><given-names>J</given-names></name><name><surname>Starr</surname><given-names>J</given-names></name><name><surname>Gitomer</surname><given-names>J</given-names></name><name><surname>Alpers</surname><given-names>CE</given-names></name></person-group><article-title>Iatrogenic phospholipidosis mimicking Fabry disease</article-title><source>Am J Kidney Dis</source><year>2006</year><volume>48</volume><fpage>844</fpage><lpage>850</lpage><pub-id pub-id-type="pmid">17060007</pub-id></element-citation></ref><ref id="B10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Woywodt</surname><given-names>A</given-names></name><name><surname>Hellweg</surname><given-names>S</given-names></name><name><surname>Schwarz</surname><given-names>A</given-names></name><name><surname>Schaefer</surname><given-names>RM</given-names></name><name><surname>Mengel</surname><given-names>M</given-names></name></person-group><article-title>A wild zebra chase</article-title><source>Nephrol Dial Transplant</source><year>2007</year><volume>22</volume><fpage>3074</fpage><lpage>3077</lpage><pub-id pub-id-type="pmid">17623715</pub-id></element-citation></ref><ref id="B11"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Selvarajah</surname><given-names>M</given-names></name><name><surname>Nicholls</surname><given-names>K</given-names></name><name><surname>Hewitson</surname><given-names>TD</given-names></name><name><surname>Becker</surname><given-names>GJ</given-names></name></person-group><article-title>Targeted urine microscopy in Anderson-Fabry disease: a cheap, sensitive and specific diagnostic technique</article-title><source>Nephrol Dial Transplant</source><year>2011</year><volume>26</volume><fpage>3195</fpage><lpage>3202</lpage><pub-id pub-id-type="pmid">21382994</pub-id></element-citation></ref><ref id="B12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fredman</surname><given-names>P</given-names></name><name><surname>Klinghardt</surname><given-names>GW</given-names></name><name><surname>Svennerholm</surname><given-names>L</given-names></name></person-group><article-title>Effect of chloroquine on the activity of some lysosomal enzymes involved in ganglioside degradation</article-title><source>Biochim Biophys Acta</source><year>1987</year><volume>917</volume><fpage>1</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">3539205</pub-id></element-citation></ref><ref id="B13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Costa</surname><given-names>RM</given-names></name><name><surname>Martul</surname><given-names>EV</given-names></name><name><surname>Reboredo</surname><given-names>JM</given-names></name><name><surname>Cigarrán</surname><given-names>S</given-names></name></person-group><article-title>Curvilinear bodies in hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease</article-title><source>Clin Kidney J</source><year>2013</year><volume>6</volume><fpage>533</fpage><lpage>536</lpage><pub-id pub-id-type="pmid">26120446</pub-id></element-citation></ref><ref id="B14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>de Menezes Neves</surname><given-names>PDM</given-names></name><name><surname>Machado</surname><given-names>JR</given-names></name><name><surname>Custódio</surname><given-names>FB</given-names></name><name><surname>Dos Reis Monteiro</surname><given-names>MLG</given-names></name><name><surname>Iwamoto</surname><given-names>S</given-names></name><name><surname>Freire</surname><given-names>M</given-names></name><name><surname>Ferreira</surname><given-names>MF</given-names></name><name><surname>Dos Reis</surname><given-names>MA</given-names></name></person-group><article-title>Ultrastructural deposits appearing as "zebra bodies" in renal biopsy: Fabry disease?- comparative case reports</article-title><source>BMC Nephrol</source><year>2017</year><volume>18</volume><fpage>157</fpage><pub-id pub-id-type="pmid">28499424</pub-id></element-citation></ref><ref id="B15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhao</surname><given-names>F</given-names></name><name><surname>Dou</surname><given-names>Y</given-names></name><name><surname>Liu</surname><given-names>D</given-names></name><name><surname>Yuan</surname><given-names>W</given-names></name><name><surname>Quan</surname><given-names>S</given-names></name><name><surname>Wang</surname><given-names>X</given-names></name><name><surname>Cheng</surname><given-names>G</given-names></name><name><surname>Xiao</surname><given-names>J</given-names></name><name><surname>Zhao</surname><given-names>Z</given-names></name></person-group><article-title>Hydroxychloroquine-induced lipidosis of the kidney mimicking Fabry disease: a case report</article-title><source>Int J Clin Exp Pathol</source><year>2016</year><volume>9</volume><fpage>2591</fpage><lpage>2593</lpage></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/ChloroquineV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000326 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000326 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= ChloroquineV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:6940343
|texte= Hydroxychloroquine-induced renal phospholipidosis resembling Fabry disease in undifferentiated connective tissue disease: A case report
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:31911921" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a ChloroquineV1
| This area was generated with Dilib version V0.6.33. |  |