Severe pulmonary tuberculosis complicated with insidious pulmonary thromboembolism: a case report and literature review

Journal of Thrombosis and Thrombolysis - Pulmonary thromboembolism (PTE) is an acute and severe disease with high mortality, which is prone to be misdiagnosed or ignored especially when complicated...     

Non-fatal gastric mucormycosis in a renal transplant patient and review of the literature

Mucormycosis is historically associated with substantial morbidity and carries a very high mortality in renal transplant patients. The common sites of involvement include cerebral, pulmonary, gastrointestinal, or disseminated lesions. We report the successful outcome of gastric mucormycosis along with Strongyloides stercoralis infection in a renal transplant patient, who has survived for 5 years. We also review the literature.     

慢性肾衰竭合并结核性胸膜炎1例附文献复习

目的 提高对肾脏疾病并发结核的认识。方法对1例经病原学检查确诊为结核性胸膜炎的慢性肾衰竭患者的临床资料进行分析，并结合文献复习，结果肾脏疾病并发结核并非罕见。结核感染既可引起肾脏损害，亦可发生存原有肾脏疾病基础上。肾脏疾病并发结核时，诊断较为困难，常需反复取样送检才能明确。结论在对肾脏疾病进行诊治过程中．需提高对结核的警惕性。     

A renal transplant patient with intractable hiccups and review of the literature

Intractable hiccups in transplanted patients may be caused by various medical conditions including infections. We report a case of a 44-year-old man who suffered from intractable hiccups after cadaveric kidney transplantation. We identified 3 different hiccup periods with different causes: 1) steroid and anesthetics use, 2) severe ulcerose herpetic and mycotic esophagitis, and 3) pleuropneumonia caused by nosocomial methicillin-resistant Staphylococcus epidermidis and pulmonary abscess requiring thoracic surgery.     

Aplastic anemia probably induced by allopurinol in a patient with renal insufficiency

A rare case of aplastic anemia which was considered to be induced by allopurinol was reported. A 48-year-old female had suffered from urolithiasis and chronic renal insufficiency. She was administered allopurinol for hyperuricemia for 4 months, and subsequently developed severe pancytopenia and bone marrow suppression. After stopping of allopurinol administration, she was administered prednisolone but died of gastro-intestinal tract bleeding and sepsis on the 21th hospital day, without hematological recovery.     

Diffuse pulmonary calcification in a patient with renal insufficiency

We report the case of a 37-year-old man with chronic renal insufficiency, on hemodialysis, with no respiratory symptoms but whose chest radiograph showed parenchymal consolidation in the middle and upper lung fields. High resolution computed tomography showed a high-attenuating diffuse alveolar pattern that indicated calcium deposits. Bronchoscopy revealed metastatic calcification on the interalveolar septa and bronchiolar and arteriolar. The present report, based on radiologic and bronchoscopic findings, describes the pathogenesis and anatomical distribution of the patient's diffuse pulmonary calcification.     

Successful treatment using cyclosporine in a patient with rhupus complicated by aplastic anemia: a case report and review of the literature

Systemic lupus erythematosus (SLE) co-morbid with rheumatoid arthritis (RA) is known as 'Rhupus syndrome' and is estimated to be present in between 0.01 and 2% of SLE and RA patients. The occurrence of aplastic anaemia in a patient with rhupus is very rare and a treatment for this condition has not been reported. A 52-year-old woman presented complaining of nausea and dizziness during the preceding month. She had been treated for rheumatoid arthritis for 16 years. At the time of presentation, she had a malar rash, multiple arthritis, pancytopenia, pleural effusion, proteinuria, and positive anti-nuclear and anti-dsDNA antibodies. A kidney biopsy revealed ISN/RPS class IV-G (A) lupus nephritis. Bone marrow aspiration and biopsy showed aplastic anaemia with no evidence of viral infection. The patient was successfully treated using cyclosporine and prednisolone and she remained symptom-free at the one-and-a-half-year follow-up. To our knowledge, this is the first report of a successful treatment using cyclosporine in a patient with rhupus complicated by aplastic anaemia.     

一例原发性肾性糖尿患者的临床与基因突变分析并文献复习

目的 通过1例原发性肾性糖尿 (primary renal glucosuria, PRG) 患者的临床特点及基因突变位点分析,结合文献复习探讨原发性肾性糖尿的作用机制、病程进展及存在的问题。方法 对华中科技大学同济医学院附属同济医院肾内科收治的1例PRG患者的基本资料、实验室检查及基因突变位点结果进行回顾性分析,并对相关文献进行复习。 结果 患者的临床表现和实验室检查符合PRG诊断。基因突变位点分析显示,患者SLC5A2基因12号外显子3’剪切位点存在IVS12 ds+1 G>A杂合突变,且对基因的功能产生影响,为致病性突变。结论 通过SLC5A2基因的突变位点分析,从遗传学方面证实患者PRG的诊断。临床上血糖正常但尿糖阳性,且无其他近端肾小管功能障碍表现的患者应考虑该疾病的可能,基因分析有助于确诊。     

Hemophagocytic lymphohistiocytosis complicated by central nervous system lesions in a patient with dermatomyositis: a case presentation and literature review

We report a case of dermatomyositis (DM) and hemophagocytic lymphohistiocytosis (HLH) complicated by central nervous system (CNS) lesions and review eight literature cases of DM and HLH. A 17-year-old woman, admitted to our hospital because of severe muscle weakness and high fever, was diagnosed with DM based on elevated serum levels of muscle enzymes and a typical skin rash. Pancytopenia, high serum ferritin and soluble interleukin (IL)-2 receptor, and hepatosplenomegaly were also noted. Bone-marrow examination was negative for hemophagocytosis. Steroid therapy combined with immunoglobulin i.v. was ineffective against the DM, pancytopenia, hepatic dysfunction, and hyperferritinemia. On the 27th hospital day, seizures and acute respiratory failure occurred. In the course of improving muscle enzyme levels after starting adjunctive treatment with cyclosporine, the patient suffered disturbed consciousness, dyskinesia, and tremor. Brain magnetic resonance imaging (MRI) revealed T2 hyperintense lesions in the pons. Additional cyclophosphamide pulse therapy successfully decreased serum ferritin. Unfortunately, the diffuse alveolar damage (DAD) confirmed by biopsy progressed and the patient died. Autopsy findings revealed DAD throughout both lungs, HLH liver lesions, and a hemorrhagic necrotic lesion of the pons in the brain. Even when pathological examination yields no findings of hemophagocytosis, it is important to comprehensively and rapidly diagnose HLH based on the clinical picture. Because DM complicated by HLH may be associated with abnormal production of cytokines and systemic autoimmune responses, it may be necessary to immediately administer additional immunosuppressive therapy. We describe and discuss the extraordinary, severe form of DM in our patient, along with cases in the literature.     

Dietary protein restriction and the progression of chronic renal insufficiency: a review of the literature

It is well known that dietary protein restriction can delay the appearance of uraemic symptoms and give symptomatic relief in patients with chronic renal failure. During the last decade, several investigators have argued that protein restriction instituted at an early phase in renal disease may influence the rate of progression of renal failure favourably. Animal experiments have given strong evidence that, in the case of nephron loss, high dietary protein promotes further loss of renal function. Many studies have been conducted to investigate the possible favourable effect of a protein-restricted diet in patients with renal disease. However, the scientific proof that long-term protein restriction delays the progression of chronic renal insufficiency in man is still missing.     

Subchondral insufficiency fracture of the femoral head in a patient with ankylosing spondylitis: Case report and literature review

Subchondral insufficiency fracture (SIF) of the femoral head occurs in patients with osteoporosis, elderly women, and renal or liver transplant recipients. Although SIF has been reported in several patients with rheumatic disease, SIF of the femoral head has not been reported in patients with ankylosing spondylitis (AS), and the association between AS and SIF has not been determined. A 48-year-old man with AS presented with pain in his left hip for 2 months. He had been diagnosed with AS and radiographic bilateral grade 3 sacroiliitis 11 years earlier. He had been treated with subcutaneous adalimumab 40 mg biweekly for more than 10 years, during which time his condition remained stable. This patient was obese but had no other known predisposing conditions, such as old age, overexertion, osteoporosis, steroid use, or transplantation. He had never taken steroids. X-rays showed no specific findings, other than mild osteoarthritis in both hips. However, pelvic magnetic resonance imaging demonstrated flattening and subchondral irregularity with a large amount of bone marrow edema, confirming a diagnosis of SIF of the femoral head. Thus, even in patients with AS having no significant risk factors, SIF should be considered as part of the differential diagnosis of hip pain.     

慢性肾脏病合并围产期心肌病1例报告附文献复习

摘要： 慢性肾脏病（CKD）合并围产期心肌病(PPCM)的风险很高,预后有别于经典PPCM,研究两者之间关联性有利于积极防控及时干预,对阻止PPCM恶化据有重要意义。通过病例回顾结合文献复习总结CKD及PPCM诊断与治疗进展,根据病史及实验室、影像学检查排除其他心脏疾病。CKD对PPCM发生发展有关,CKD孕妇必须定期进行包括心脏在内的血、尿及影像学孕期检查;发生急慢性心力衰竭者按治疗指南处理相关病情,同时纠正CKD产生的各种不利因素。积极治疗CKD,给予以ACEI（ARB）+β受体阻滞剂或+盐皮质激素受体拮抗剂（MRA）为基础心力衰治疗+靶向治疗可以逆转心脏结构损伤,改善心脏功能及肾功能,提高生存质量,降低死亡率。     

Gadodiamide-based coronary angiography in a patient with severe renal insufficiency

The risk of contrast-induced nephropathy (CIN) is extremely high in patients with preexisting renal insufficiency. Gadolinium-based coronary angiography has been proposed as an approach to prevent CIN in this high risk subgroup. We report the use of gadodiamide-based coronary angiography in a patient with severe renal insufficiency and in vitro comparisons of combinations of iodinated contrast with gadodiamide and saline.     

Severe acute Q fever pneumonia complicated by presumed persistent localized Q fever endocarditis in a renal transplant recipient: A case report and review of the literature

Q fever in solid organ transplant (SOT) recipients is rarely described in the medical literature. We present a case of severe acute Q fever pneumonia that evolved into persistent localized Q fever endocarditis in a renal transplant recipient.     

Severe hemolysis and SIADH-like symptoms induced by vincristine in an ALL patient with liver cirrhosis

An 11-year-old boy was diagnosed as having acute lymphoblastic leukemia (ALL, L1) in 1987 and underwent treatment with an ALL high-risk protocol (prednisolone, vincristine (VCR), daunorubicin, 1-asparaginase), which resulted in complete remission. In 1990 he developed chronic hepatitis C and received interferon therapy. In December 1994, ALL recurred, and the patient was treated with VCR. He subsequently developed severe hemolysis (Hb 12.5 g/dl-->6.8 g/dl) with increases of indirect bilirubin, AST, and LDH. Furthermore, symptoms resembling a syndrome of inappropriate secretion of ADH (SIADH) and DIC developed. Upon incubation of the patient's red blood cells with VCR in vitro, extreme deformity of the cells was observed. These findings suggested that splenomegaly, due to liver cirrhosis which had developed rapidly from chronic hepatitis C while the patient was in an immunosuppressed state induced by anticancer drugs, had trapped the deformed red blood cells and resulted in severe hemolysis. The patient died on the 165th day after admission due to liver failure.     

Percutaneous intervention of spontaneous renal artery dissection complicated with renal infarction: a case report and literature review.

Spontaneous renal artery dissection (SRAD) is a rare condition that occurs before renal infarction. Using percutaneous intervention to treat SRAD remains controversial because it is not clear whether it is feasible or effective. We describe a 48-year-old male patient with SRAD complicated with renal infarction who was successfully treated with percutnaeous angioplasty and renal artery stenting.     

Prevention of progressive renal failure by levothyroxine sodium in a diabetic patient with renal insufficiency and hypothyroidism.

The progressive renal failure of a 49-year-old female diabetic patient with renal insufficiency and hypothyroidism was successfully prevented by levothyroxine sodium treatment. Her renal function worsened in parallel with the exacerbation of hypothyroidism. Cessation of progressive renal failure was observed after administration of levothyroxine sodium (0.05 mg daily) for more than 24 months. Mean slopes of reciprocal serum creatinine levels for 12 months before and after the administration of levothyroxine sodium were -1.67 x 10(-3) and +8.68 x 10(-4), respectively. It was suggested that levothyroxine sodium was effective in the prevention of progressive renal failure in this patient.     

Dysphagia in a patient with lupus and review of the literature

Dysphagia is not infrequent in patients with connective tissue diseases such as scleroderma, polymyositis or systemic lupus erythematosus (SLE). It is usually the result of gastro-oesophageal reflux but dysmotility can equally be responsible. A case of dysphagia is described in a patient with SLE, who had developed a rare variety of bullous mucous disease affecting the whole length of oesophagus with spontaneous extrusion of an oesophageal cast. Histological features were suggestive of a variant of rare form of bullous disease in SLE called epidermolysis bullosa acquisita (EBA). This rare association of SLE and EBA involving the oesophagus has not been described in the literature.