Rapid Responses to:

PRACTICE: Chris M Laing, Rhys Roberts, Liz Lightstone, Alison Graham, Terry H Cook, Shaun Summers, and Charles D Pusey A patient with suspected miscarriage is found to have hypertension, renal failure, and thrombocytopenia: case outcome BMJ 2007; 335: 205-206 [Full text]

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Rapid Responses published:

Challenging!

Dr. Cristina Verdaguer   (27 July 2007)

Interesting case..

Prasanta Padhan   (29 July 2007)

Nothing Impossible

Chandra Mauli Jha, Oman   (4 August 2007)

Challenging! 27 July 2007
Dr. Cristina Verdaguer, Nephrologist Private Hospital Uruguay Send response to journal: Re: Challenging!	I would like to thank and congratulate Dr.Laing for presenting this complex and rare case. It was a challenge for me because I replied without looking for any information as if I were treating the patient at this moment. I have never seen a sclerodermal crisis, but with the results of the angiography the diagnosis was clear. The diagnosis of malignant hypertension and the treatment was clear for me almost since the beginning as well as the suspect of an underlying disease (though I did not think in sclerodermal crisis) I look forward to participating in new cases according to my speciality Competing interests: None declared
Interesting case.. 29 July 2007
Prasanta Padhan, Post Doctoral Fellow CMC,Vellore,India.632004 Send response to journal: Re: Interesting case..	Usually patient with scleroderma renal crisis have diffuse cutaneous disease(1).The fact that this patient did not have is interesting.A follow up may help to confirm this diagnosis.Possibility of a Scleroderma overlap with SLE can not be ruled out at the moment.However the therapeutic strategy at the moment remains the same. Reference: (1)Penn H et al.Scleroderma renal crisis: patient characteristics and long -term outcomes.QJM. 2007 Aug;100(8):485-94 Competing interests: None declared
Nothing Impossible 4 August 2007
Chandra Mauli Jha, Incharge Nephrologist Rusatq Regional Hospital, Rustaq., Oman Send response to journal: Re: Nothing Impossible	The complete excercise was interesting. It affirmed that every possibility considered in differential diagnsis stands a chance of being correct unless disproved. I personally was keeping SLE higher than Sclerodermal renal crisis. The only clue in favour of the later was malignant hypertension and history of Raynaud's Phenomenon. While Raynaud's may be present in SLE too, malignant hypertension is not so common unless associated with renal failure. To be honest, I would have argued hard against the sclerodermal renal crisis had not there been the clue of earlier successful pregnancies and onother clue that your team was treating the patient with incremental dose of captopril. It would have been interesting to know about thre sex of her children. Competing interests: None declared