title: Mistaken identity: normotensive scleroderma renal crisis.
abstract: A patient presented with neuromuscular, respiratory and cardiac symptoms and was initially diagnosed with amyotrophic lateral sclerosis (ALS), myocardial ischaemia and pneumonia. He developed unexplained progressive kidney failure over the ensuing week, and his kidney biopsy showed thrombotic microangiopathy that led to the correct diagnosis of normotensive scleroderma renal crisis. His clinical presentation and course were consistent with systemic sclerosis and normotensive scleroderma renal crisis. He was treated with an ACE inhibitor (ACEi) and haemodialysis with significant functional improvement over the next 3 months to his prior baseline with the exception of kidney failure. This case highlights a diagnostic challenge requiring astute history and physical examination skills, and the value of a kidney biopsy in providing the final diagnosis.
authors.affiliation: Department of Medicine, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Arwa
authors.initials: A
authors.lastname: Aburizik
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Medicine, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Laith
authors.initials: L
authors.lastname: Al-Rabadi
authors.affiliation: Department of Medicine-Nephrology, University of Washington, Seattle, Washington, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Blosser
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000473:pathology; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis*; D001706:Biopsy; D001794:Blood Pressure; D003951:Diagnostic Errors; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis