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Spinal Tuberculosis (Two Cases)

revealed a reduction in labile crosslinks, suggesting that D-penicillamine was inhibiting new dermal collagen formation. Despite an episode of exfoliative dermatitis she remained on D-penicillamine therapy with steroid cover and continued to improve. The patient was readmitted in June 1974 as an emergency due to the sudden onset of grand mal convulsions, cerebral cedema and renal failure. Her blood pressure was 170/120 mmHg, blood urea 170 mg/100 ml, and there was oliguria. Despite peritoneal dialysis she eventually died in pulmonary cedema. At post-mortem, apart from typical skin changes, the kidneys showed evidence of interlobular fibrosis in the parenchyma, arteriolar intimal fibrous proliferation and glomerular tuft swelling with fibrinoid necrosis. These changes confirmed the diagnosis ofPSS with renal involvement.