Unusual Clinical Features Research Articles

A case report of an oral hemangioma with unusual features.

A 26-year-old patient with swelling on the lingual surface of the mandible in the incisors area was referred to the Faculty of Dentistry at Mashhad University of Medical Sciences. After conducting clinical, radiographic, and pathological examinations, the patient was diagnosed with capillary hemangioma. This study explores the clinical manifestation and unusual behavior of intraoral hemangioma. Hemangioma is a tumor that occurs due to the proliferation of endothelial cells in 4%-5% of infants and affects the head and neck region in almost 70% of cases. The tumor in the mouth can appear as a soft, smooth, or lobulated mass with or without a base and varying in size from a few millimeters to a few centimeters. This article reports a case of hemangioma with unusual clinical features in a 26-year-old male patient.

A novel variant BCL11B mutation in a pediatric patient with difficult‐to‐treat eosinophilic esophagitis

AbstractEosinophilic esophagitis (EoE) is an immunoinflammatory disease of the esophagus attributable to a complex interaction between genetic and environmental factors. While several genetic risk variants have been linked with EoE, we report a novel association between B‐cell lymphoma/leukemia 11B genetic mutation in a child with dysmorphic facies, developmental delays, atopic comorbidities, and difficult‐to‐treat EoE. After a prolonged course of EoE and multiple esophagogastroduodenoscopies with biopsies, this patient achieved clinical and histologic remission on a combination of swallowed topical steroids and high‐dose proton pump inhibitor (PPI) therapy. However, her EoE relapsed when we attempted to wean her off PPI, and it was finally controlled after adding PPI back to her regimen. This report underscores the importance of genetic testing in patients with unusual clinical features and difficult‐to‐treat EoE. Relevant to real‐world clinical practice, this case also raises the question of the treatment goals in children with EoE and underlying genetic mutation(s).

Dengue-Related Hemophagocytic Lymphohistiocytosis in an Adult: A Case Report and Brief Update

AbstractDengue virus is an arbovirus transmitted through the bite of infected Aedes mosquitoes. Many unusual clinical features are being reported in dengue. Dengue complicated with hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal condition. Here, we report an 18-year-old otherwise healthy female with dengue fever complicated with HLH. The diagnosis was made by fulfilling the clinical and laboratory criteria of HLH. She was managed successfully with a methylprednisolone pulse regimen. Our case highlights the importance of early recognition of complications and prompt treatment for a better outcome.

AChR-seropositive myasthenia gravis in muscular dystrophy: diagnostic pitfalls and clinical management challenges.

The co-occurrence of genetic myopathies with myasthenia gravis (MG) is extremely rare, however a few studies have been reported. We aim to explore the link between genetically inherited muscle disorders and immune-mediated neuromuscular junction conditions, taking into account the diagnostic and therapeutic implications posed by these combined conditions. We searched all English medical papers registered in Web of Knowledge, PubMed, Google Scholar, and Science Direct between January 1987 concerning the association between muscular dystrophies (MD) and MG, also adding three new cases to the series reported so far. Three new clinical cases in which MG concurs with oculopharyngeal muscular dystrophy (OPMD) or facioscapulohumeral muscular dystrophy (FSHD) or myotonic dystrophy type 2 (DM2) were reported. A comprehensive literature review showed that FSHD is the dystrophy most frequently associated with generalized MG. The AChR antibody titer is high and neurophysiologic tests prove to be an essential tool for the diagnosis. The association between MG and MD is rare but should not be underestimated. The presence of unusual clinical features suggest investigating additional overlapping condition, especially when a treatable disease like MG is suspected.

Paraneoplastic Syndromes in Hepatocellular Carcinoma, Epidemiology, and Survival: A Retrospective Seven Years Study.

Background and Objectives: Liver cancer poses a significant global health threat, ranking among the top three causes of cancer-related deaths. Patients with hepatocellular carcinoma (HCC) often present with symptoms associated with neoplasms or unusual clinical features such as paraneoplastic syndromes (PNS), including hypoglycemia, hypercholesterolemia, thrombocytosis, and erythrocytosis. Our study aimed to investigate the prevalence, clinical characteristics, and survival outcomes associated with PNS in HCC patients and assess each PNS's impact on patient survival. Materials and Methods: We conducted a retrospective analysis of PNS clinical features and survival among consecutive HCC patients diagnosed at our department over seven years, comparing them with HCC patients without PNS. The study involved a retrospective data evaluation from 378 patients diagnosed with HCC between January 2016 and October 2023. Results: We obtained a PNS prevalence of 25.7%, with paraneoplastic hypercholesterolemia at 10.9%, hypoglycemia at 6.9%, erythrocytosis at 4.5%, and thrombocytosis at 3.4%. Patients with PNS tended to be younger and predominantly male. Multivariate analysis revealed a strong correlation between PNS and levels of alpha-fetoprotein and tumor size, with diabetes also showing a significant statistical association (p < 0.05). Subgroup analysis based on specific paraneoplastic syndromes demonstrated shorter survival in patients with PNS, albeit without significant statistical differences, except for hypoglycemia (p < 0.0001). Matched analysis indicated a shorter survival rate for patients with PNS, although no significant statistical differences were observed. Conclusions: PNS are frequently observed in HCC cases and are associated with unfavorable prognoses and decreased survival rates due to their correlation with increased tumor burdens. However, they do not independently predict poor survival. The impact of individual PNS on HCC prognosis varies.

Unusual imaging findings associated with abdominal pediatric germ cell tumors.

Germ cell tumors of childhood are tumors arising from germline cells in gonadal or extragonadal locations. Extragonadal germ cell tumors are characteristically located in the midline, arising intracranially or in the mediastinum, retroperitoneum, or pelvis. These tumors are generally easily diagnosed due to typical sites of origin, characteristic imaging findings, and laboratory markers. However, germ cell tumors can be associated with unusual clinical syndromes or imaging features that can perplex the radiologist. This review will illustrate atypical imaging/clinical manifestations and complications of abdominal germ cell tumors in childhood. These features include unusual primary tumors such as multifocal primaries; local complications such as ovarian torsion or ruptured dermoid; atypical presentations of metastatic disease associated with burned-out primary tumor, growing teratoma syndrome, and gliomatosis peritonei; endocrine manifestations such as precocious puberty and hyperthyroidism; and antibody mediated paraneoplastic syndrome such as anti-N-methyl-D-aspartate-receptor antibody-mediated encephalitis. This review aims to illustrate unusual imaging features associated with the primary tumor, metastatic disease, or distant complications of abdominal germ cell tumors of childhood.

Case report: juxtaglomerular cell tumour with unusual clinical and histopathological features

Case report: juxtaglomerular cell tumour with unusual clinical and histopathological features

COVID-19 Outbreak in a Neonatal Intensive Care Unit During Third Pandemic Wave: A Case Series

The case series aims to provide insights into the clinical presentation, diagnosis, management, and outcomes of neonates infected with COVID-19 during the third wave. We highlight the unusual clinical features, especially incessant cough even in extremely premature neonates, and the mode of horizontal transmission that led to this outbreak. A high index of suspicion and timely diagnosis of COVID-19 in neonates can help avoid the overdiagnosis of clinical sepsis and limit the inadvertent use of antibiotics. The report adds valuable information to the literature for clinicians caring for neonates during the ongoing COVID-19 pandemic.

Gastrointestinal Manifestations of Dengue Fever among Children: A Multicenter Cross-Sectional Study in Bangladesh

Background: Dengue fever is an arboviral illness spread by mosquitoes and is now a major public health issue on a global scale. Unfortunately, only few studies have documented unusual clinical characteristics of dengue among children. Objective: The objective of this study was to describe the gastro intestinal manifestations of dengue infected children during 2019 dengue outbreak in Dhaka city. Methodology: This cross-sectional study was conducted at Department of Virology at National Institute of Laboratory Medicine and Referral Center, Dhaka, Bangladesh among confirmed cases of dengue fever (Children aged less than 12 years) admitted in the pediatric ward of Dhaka Medical College Hospital, Kurmitola General Hospital, Sir Sallimullah Medical College Hospital, Dr M R Khan Sishu Hospital and BSMMU in Dhaka from June 2019 to November 2019 for period of six months. Data was collected using a structured questionnaire via face-to-face interview from guardian of the children. The investigation profile was collected from their hospital records. Results: Out of confirmed 200 pediatric dengue patients, children with dengue had an average age of 9.8±2.7 years with a slight female predominance. The majority (36.5%) of the children belonged to the age group of 5 to 9 years. Among 200 patients, 42 patients diagnosed as severe Dengue according to WHO classification. Gastrointestinal symptoms were the most common associated feature, including mostly Nausea/vomiting (81.0%), abdominal pain (61.0%), ascites (29.0%), hepatomegaly (19.0%), diarrhoea (13.0%) and others. Elevation of transaminases was found in 40.0% of the children. About 30% of the patients had platelet count more than or equal to 50000 and hematocrit more than 40 was observed in 12% patients. Atypical manifestations such as acalculous cholecystitis, acute fulminant hepatitis, acute pancreatitis, parotitis, AKI and paralytic ileus were noted in small number of patients. Conclusion: In conclusion, fever with vomiting and abdominal pain are common presentations of dengue fever. Bangladesh Journal of Medical Microbiology, July 2023;17(2):66-70

Primary Chest Wall Ewing Sarcoma with Indolent Behavior in an Elderly Male

Abstract Introduction/Objective Ewing sarcoma (ES) is the second most common primary malignant bone tumor, primarily affecting children and young adults within the first two decades of life. Over 80% of cases are positive for CD99 and exhibit a characteristic t(11;22) translocation resulting in an EWSR1::FLI1 fusion. Extraosseous ES is extremely rare and most reported cases occur in patients less than 50 years old. We report an unusual case of extraosseous ES arising from the chest wall in an elderly male that showed slow interval progression on imaging studies. Methods/Case Report An 83-year-old male with a past medical history of COPD and tobacco use presented to the emergency department for a mechanical ground level fall and a worsening cough over the prior week. Of note, he was found to have a 6.1 cm pleural based mass seven years prior. The patient was ultimately discharged home with recommended oncologic follow-up for this long-standing chest wall mass due to an increase in size on imaging. A PET scan showed a hypermetabolic subpleural mass in the right lower chest wall measuring 7.6 cm with invasion through the adjacent ribs and intercostal spaces into the adjacent soft tissue. A core biopsy was performed, which demonstrated a small round blue cell tumor diffusely positive for CD99 and Bcl-2, lacking significant mitotic activity and necrosis. Given the unusual clinical features, a next generation sequencing (NGS) panel for sarcoma fusions was performed and identified an EWSR1::FLI1 fusion, supporting the diagnosis of ES/primitive neuroectodermal tumor (PNET). Results (if a Case Study enter NA) NA Conclusion ES is relatively common as a primary bone tumor in children and young adults, but is rare in the chest wall and pleura and is extremely rare in the elderly. The clinical course for ES is typically aggressive. Diagnosis of ES can be challenging as CD99 positivity is nonspecific. The characteristic t(11;22) EWSR1::FLI1 fusion can be identified through FISH or NGS. At 83 years old, this is, to our knowledge, the oldest patient reported in the literature with this diagnosis. The slow interval growth of this mass over a period of seven years is also unusual. These combined clinicopathologic features are exceedingly unique and expand upon the reported spectrum and behavior of the Ewing’s family of sarcomas. The use of broad NGS panels among pathologists may result in increased identification of ES in unusual clinical settings in the future, while also providing more confident pathologic classification in challenging situations.

Serotype Variations and Distributions of Dengue Virus During the 2022 Outbreak in Chattogram, Bangladesh

Introduction: In the year 2022, a Dengue virus outbreak occurred nationwide in Bangladesh, including Chattogram, a port city. The purpose of this study was to identify and document the serotypes of Dengue virus and to measure the viral load of the virus positive specimens. Methods: This observational study was conducted in a tertiary care hospital of Chattogram during a period of six months from June through December, 2022. A total of 74 patients with symptoms suggestive of Dengue Fever(DF) and NS1 or IgM/IgG positive dengue patients were recruited into the study. From them clinicopathological data was collected on a case record form(CRF). Ten ml of venous whole blood was drawn in EDTA tubes then centrifuged and was sent to the laboratory at SlieaGen L.L.C in Austin, Texas, USA, for Dengue serotyping and viral load analysis by qPCR-LDT method. A total of 73 specimens were analyzed, one specimen was excluded. Ethical clearance was obtained from the hospital ethical review board, written informed consents were also taken from all subjects. Serotyping and qPCR testing data was shared by SlieaGen LLC once analysis was completed. Results: Amongst the 74 patients most were male 57(77%) and most [20(40.5%)] patients were young at 21-30 years. All had history of fever(100%), followed by body aches 67(90.5%), headache 49(66.2%) and weakness 55(74.3%). Positive NS1, IgM Dengue Ab and IgG Dengue Ab were found in 68(91.9%), 8(10.8%) and 3(4.1%) cases respectively. Frequency of serotype distributions revealed DENV 1 and DENV 3 were the most common serotypes 25(33.8%) and 16(21.6%) respectively also DENV 2 was 3(4.1%) and DENV 4 was 1(1.4%). Among 27 virus positive cases single infection DENV 1 was found in 10(13.51%) samples, DENV 3 and DENV 4 found in 1(1.4%) samples each, doubly infected (DENV 1 + DENV 2) was found in 12(16.2%) samples, triple infected (DENV 1 + DENV 2 + DENV 3) was found in 3(4.1%) samples. No virus was detected in 46(62.16%) samples. Viral load (Mean ± SD ) found in DENV 1(890974.48 ± 4156206)cp/ml, DENV 2 (33423.00 ± 9088.35)cp/ml, DENV 3(23991.12 ± 51250.18)cp/ml and DENV 4 (822.00cp/ml) in virus detected samples Conclusions: All four serotypes were found in the 2022 Dengue outbreak in Chittagong and DENV 1 and DENV 3 were common serotype. Simultaneous double and triple serotype infection in the same patients may be related with different unusual clinical features which need further documentations in future. J Bangladesh Coll Phys Surg 2023; 41: 39-43

Two Cases of Unusual Clinical Features of Keratoacanthoma

The Iraqi and the Yemeni dental literature lack documentation of keratoacanthoma (KA). It uncommonly appears at the mucocutanous junction and very rarely reported to arise in the mucous membrane. Nevertheless, it has such a chance; therefore, it is necessary to bring the attention of dental practitioners to this lesion. It is a benign epithelial tumor that frequently affects the face of old people. It usually, appears as an exophytic nodule with a central keratin plug that grows rapidly but with several poses. Clinically and microscopically KA is similar to squamous cell carcinoma (SCC) and can be occasionally misdiagnosed therefore it is important to be biopsied and carefully interpreted. This report presents two clinically unusual cases of KA.

Clinical boundaries in adult cases of large B cell lymphoma with IRF4 rearrangement.

Large B-cell lymphoma with IRF4 rearrangement (LBCL-IRF4) is a recently described entity included in the revised 4th edition of the WHO Classification of Haematolymphoid Tumours (2017). Here we highlight the difficulties in classification of those cases which arise in adult patients with unusual clinical features. We present three cases with morphological and immunohistochemical features consistent with large B-cell lymphoma arising in adult patients, which were found to have isolated IRF4 rearrangements on FISH analysis. Each patient presented with advanced-stage disease and had a history of immunosuppression; clinical features that are not typical of LBCL-IRF4 and which make the distinction from DLBCL, not otherwise specified (NOS) challenging. We propose that the clinical boundaries of LBCL-IRF4 arising in adult patients need further delineation to allow distinction from true cases of DLBCL, NOS.

Congenitalis gyorsan növekvő óriás tumorok egy újszülött esetében

The authors present a juvenile xanthogranuloma case with unusual clinical features. The results of the checkupand the differential diagnosis’ respects. They discuss the novel treatment options based on the recent literature and refer to the results of the therapy in their patient. The case presents an extraordinary, rapidly growing, malignant tumor-mimicking variant of the benign, mostly spontaneously regressing juvenile xanthogranuloma.

Cytomegalovirus anterior uveitis and occlusive retinal vasculitis without retinitis in a patient on immunomodulatory therapy

PurposeTo describe unusual clinical features and therapeutic management of a case of cytomegalovirus (CMV) ocular disease in a patient on immunomodulatory therapy.Setting/venueMoorfields Eye Hospital NHS Foundation Trust, London, UK.MethodsMedical history, clinical findings, investigation results, and multimodal imaging were retrospectively collected.ResultsA 61-year-old, South-East Asian man, developed CMV-related endotheliitis and occlusive retinal vasculitis, diagnosed by wide-angle fluorescein angiography. No retinitis was present on the fundus examination. Suspicion of CMV etiology was based on anterior segment findings, especially the presence of coin-shaped endothelial lesions. The diagnosis was confirmed by aqueous polymerase chain reaction (PCR) analysis which was positive for CMV DNA. The combined use of topical and systemic valganciclovir resulted in significant improvement of the picture.ConclusionsCMV can manifest in the eye as occlusive retinal vasculitis without the presence of typical retinitis.

Absence of Oligoclonal Bands in Multiple Sclerosis: A Call for Differential Diagnosis.

Immunoglobulin gamma (IgG) oligoclonal bands (OCB) in the cerebrospinal fluid (CSF) are absent in a small group of multiple sclerosis (MS) patients. According to previous research, OCB-negative MS patients differ genetically but not clinically from OCB-positive MS patients. However, whether OCB-negative MS is a unique immunological and clinical entity remains unclear. The absence of OCB poses a significant challenge in diagnosing MS. (1) Objective: The objective of this study was twofold: (1) to determine the prevalence of OCB-negative MS patients in the Uppsala region, and (2) to assess the frequency of misdiagnosis in this patient group. (2) Methods: We conducted a retrospective study using data from the Swedish MS registry (SMSreg) covering 83% of prevalent MS cases up to 20 June 2020 to identify all MS patients in the Uppsala region. Subsequently, we collected relevant information from the medical records of all OCB-negative MS cases, including age of onset, gender, presenting symptoms, MRI features, phenotype, Expanded Disability Status Scale (EDSS) scores, and disease-modifying therapies (DMTs). (3) Results: Out of 759 MS patients identified, 69 had an OCB-negative MS diagnosis. Upon re-evaluation, 46 patients had a typical history and MRI findings of MS, while 23 had unusual clinical and/or radiologic features. An alternative diagnosis was established for the latter group, confirming the incorrectness of the initial MS diagnosis. The average EDSS score was 2.0 points higher in the MS group than in the non-MS group (p = 0.001). The overall misdiagnosis rate in the cohort was 33%, with 22% of misdiagnosed patients having received DMTs. (4) Conclusions: Our results confirm that the absence of OCB in the CSF should raise suspicion of possible misdiagnosis in MS patients and prompt a diagnostic reassessment.

Analytically confirmed illicit and novel psychoactive drug use in Western Australian emergency departments: initial results from the Emerging Drugs Network of Australia (EDNA)

Introduction The burden of acute illicit drug use in Australia is largely unknown. Establishing a prospective drug surveillance system in emergency departments using analytical confirmation may facilitate the early identification of emerging drugs. We describe demographic data and acute toxicity patterns, stratified by analytical confirmation of illicit drugs and novel psychoactive substances, to emergency departments in Western Australia. Methods Patients presenting with severe and/or unusual clinical features consistent with recreational drug toxicity were identified across five Western Australian emergency departments participating in the Emerging Drugs Network of Australia between April 2020 and December 2021. Demographic and toxicology patterns in patients with and without analytically confirmed illicit drugs/novel psychoactive substances from blood samples were collected during the emergency department presentation. Results The cohort included 434 severe and/or unusual toxicology presentations; median age 33 years (first and third quartiles 25–40 years), 268 (61.8%) males. Any substance (illicit, novel psychoactive substance, pharmaceutical) was detected in 405 (93.3%) presentations. Illicit drugs/novel psychoactive substances were detected in 257 (59.2%) presentations, including 73 (28.3%) with more than one confirmed illicit drug/novel psychoactive substance. Frequent illicit drugs identified were metamfetamine (n = 201, 77.9%) and gamma-hydroxybutyrate (n = 30, 11.6%). Forty-eight novel psychoactive substances were detected within 43 (16.7%) presentations. Novel benzodiazepines were most frequently detected (n = 29, 60.4%). Frequent pharmaceuticals detected included diazepam (n = 100, 26.1%) and clonazepam (n = 40, 10.4%). One hundred and fifty-five (35.7%) presentations were discharged home and 56 (12.9%) were admitted to intensive care. Presentations with detected illicit drugs/novel psychoactive substances had a lower median intensive care length of stay compared to presentations without detected illicit drugs/novel psychoactive substances (32.6 h versus 50.8 h respectively, P < 0.001). Conclusions Integration of clinical and analytic data in patients with severe and/or unusual toxicology presentations via the Emerging Drugs Network of Australia provides insight into illicit drug/novel psychoactive substance use responsible for acute harm across Western Australian emergency departments.

Hemophagocytic lymphohistiocytosis as a rare complication of dengue haemorrhagic fever: a case report

BackgroundHaemophagocytic lymphohistiocytosis (HLH) is an uncommon systemic inflammatory syndrome that can happen secondary to numerous conditions. It rarely occurs due to dengue infection causing significant mortality and morbidity even with appropriate treatment. The outcome is further poor if the diagnosis of HLH is delayed or left untreated. Therefore, a high degree of clinical suspicion is paramount in diagnosing HLH.Case presentationA 17-year-old Sinhalese boy was admitted to a tertiary care hospital in Sri Lanka with a 4-day history of fever, headache, nausea, vomiting, and diarrhea. He was hemodynamically stable, and the serological investigation confirmed a dengue infection. On the fifth day of fever, he entered the critical phase of dengue infection, confirmed by ultrasound evidence of plasma leaking. However, he had ongoing high fever spikes during the critical phase, and even after the critical phase was over, the fever spikes continued. Simultaneously, hepatosplenomegaly was noticed, and he showed persistent thrombocytopenia, neutropenia, and anemia despite the resolution of the critical phase. Further, the workup revealed a serum ferritin level of > 3000 ng/mL triglyceride level of 314 mg/dL, and the bone marrow biopsy revealed an increased haemophagocytic activity. Secondary HLH was diagnosed on the basis of criteria used in the HLH-2004 trial and successfully managed with intravenous dexamethasone 10 mg/body surface area/day for the first 2 weeks, followed by a tapering regimen over 8 weeks.ConclusionThis case emphasizes the need to consider HLH as a potential complication when persistent fever and cytopenias are present after recovering from dengue fever, particularly in patients with unusual clinical features like hepatosplenomegaly. Early recognition and prompt treatment with appropriate immunosuppressive therapy, such as intravenous dexamethasone, can lead to a successful response and good prognosis.

Surgical management of a rare giant ovarian serous cystadenoma with distinctive clinical manifestations

Abstract Giant ovarian cysts are categorized with sizes &amp;gt;10 cm. After reaching huge diameters, these rare tumors cause clinical symptoms such as nausea, vomiting or abdominal pain. We present a 29-year-old woman with a giant unique cystadenoma represented with unusual clinical features like low back pain and progressive constipation. Specific imaging methods demonstrated an adnexal lesion in the form of an enormous ovarian cyst; afterward, an open laparotomy was recommended to access the abdominal cavity. The critical role of timely diagnosis and accurate workups for giant ovarian cysts in increasing patients’ life expectancy and quality of life is discussed.

Clinical profile of children with acute post-streptococcal glomerulonephritis.

Acute post-streptococcal glomerulonephritis (APSGN) is common in developing countries with a high hospitalization rate. Most patients have acute nephritic syndrome features, although some occasionally present with unusual clinical features. This study aims to describe and analyze clinical features, complications, and laboratory parameters in children diagnosed with APSGN at presentation, 4 and 12weeks later, in a resource-limited setting. This cross-sectional study was conducted among children < 16years with APSGN between January 2015 and July 2022. Hospital medical records and outpatient cards were reviewed for clinical findings, laboratory parameters, and kidney biopsy results. Descriptive analysis of multiple categorical variables was performed using SPSS version 16.0 and presented as frequencies and percentages. The study included 77 patients. Most (94.8%) were older than five years, and age group 5-12years had highest prevalence (72.7%). Boys were affected more frequently than girls (66.2% vs. 33.8%). Edema (93.5%), hypertension (87%), and gross hematuria (67.5%) were the most frequent presenting symptoms, and pulmonary edema (23.4%) was the most common severe complication. Anti-DNase B and anti-streptolysin O titers were positive in 86.9% and 72.7%, respectively, and 96.1% had C3 hypocomplementemia. Most clinical features resolved in three months. However, at 3months, 6.5% of patients had persistent hypertension, impaired kidney function, and proteinuria alone or in combination. Most patients (84.4%) had an uncomplicated course; 12 underwent kidney biopsy, 9 required corticosteroids, and 1 required kidney replacement therapy. There was no mortality during the study period. Generalized swelling, hypertension, and hematuria were most common presenting features. Persistent hypertension, impaired kidney function, and proteinuria persisted in a small proportion who had a significant clinical course and required kidney biopsy. A higher resolution version of the Graphical abstract is available as Supplementary information.