A 56-year-old woman with scleroderma developed rapidly progressive glomerulonephritis with epithelial crescents associated with hemoptysis after 27 months of D-penicillamine therapy and a cumulative dose of 1,200 g. Renal failure necessitated 5 hemodialysis sessions. D-penicillamine was withdrawn and glucocorticoids combined with azathioprine were given with good recovery of renal function. The 9 other reported cases of D-penicillamine induced rapidly progressive glomerulonephritis have been reviewed. This syndrome is potentially life-threatening: the 5 untreated patients died, whereas 5 patients given immunosuppressive therapy are alive.
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