Abstract
caused by immune complex formation, by paraproteins, with subsequent complement activation.” This mechanism is not likely in our patient because of the absence of cryoglobulins, the negative Clq binding assay, and the absence of immune complexes in the biopsy. Antibody activity against neuronal tissue, like MAG antibodies, as a possible mechanism of neuropathy7 has also been excluded in our patient. We conclude that the vasculitis in this patient is not related to the multiple myeloma but to the PAN. The presence of cANCA and antibodies against PR3 further support this diagnosis.” The role of autoantibodies in the pathogenesis of vasculitis, however, remains unknown. M etformin (MET), a dimethylbiguanide antihyperglycemic agent, has shown promise for its efficacy in improving glycemic control while causing adipose tissue and weight loss in obese non-insulindependent diabetic (NIDDM) patients.‘-” Unlike its predecessor, phenformin, which was removed from the US market in the 197Os, MET has less propensity for causing lactic acidosis, although in certain subgroups of patients, including those with renal insufficiency in whom MET elimination is decreased, the risk of lactic acidosis remains a serious concern.“,” Well-documented cases of metformin-associated lactic acidosis (MALA) in patients with chronic renal failure are few,i,8 and to our knowledge, no case of MALA has been reported in a patient already on peritoneal dialysis (PD).“,‘” We describe MALA in a renal failure patient on PD who was inadvertantly given MET and survived this life-threatening complication.
Published Version
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