Clinical evaluation of pneumonia-associated rhabdomyolysis with acute renal failure

This study aims to evaluate the clinical features, diagnosis, and treatment efficacy in patients with pneumonia-associated rhabdomyolysis and acute renal failure. The subjects included six patients who had presented with rhabdomyolysis and acute renal failure due to bacterial or viral pneumonia on admission to our university hospital and the Yokohama Social Insurance Central Hospital between 2004 and 2005. The causative organisms were identified as Legionella pneumophila (N = 1), Staphylococcus epidermidis (N = 2), Staphylococcus aureus (N = 1), and Unknown (N = 2). For anuric or oliguric patients (N = 4), a blood purification therapy was performed, while conservative therapy was administered to those with a normal urine volume (N = 2). The patient suffering from L. pneumophila pneumonia did not survive, while the other patients regained full kidney function. It is important to identify, evaluate, and treat patients with bacterial or viral pneumonia-associated rhabdomyolysis and acute renal failure.     

Rhabdomyolysis and acute renal failure in a polymyositis patient

Abstract

Multicentric reticulohistiocytosis (MR) is an uncommon disease characterized by joint and cutaneous manifestations. The diagnosis must be confirmed by histological evidence of typical histiocytes and multinucleated giant cells. Many conditions, including malignancy, have been described in association with MR. We herein report a female case of MR in whom partial improvement was obtained by steroid and low-dose methotrexate treatments. However, ovarian cancer was found and therefore a surgical resection and chemotherapy were performed. These treatments resulted in the complete resolution of the skin and joint symptoms. These findings support the close linkage between MR and malignancy and the efficacy of cytotoxic drugs for the treatment of MR.     

Acute pericarditis after dengue fever

A 63-year-old woman was admitted for acute chest pain and asthenia worsening for one week. Clinical examination was normal. ECG revealed widespread T waves depression. Echocardiography, cardiac MR-scan, biological examinations and coronary angiogram were normal except positive dengue fever serologies. She had suffered from dengue fever recently. Clinical and ECG outcomes were good under treatment. Cardiac complications are scarce in case of dengue fever. In this case report, clinical and especially ECG presentation are typical of acute pericarditis. This pericarditis is due to dengue fever.     

A rare case of enteropathy-associated T-cell lymphoma presenting as acute renal failure

Enteropathy-associated T-cell lymphoma (EATCL) is a high grade, pleomorphic peripheral T-cell lymphoma usually with cytotoxic phenotypes. We describe a first case of patient with EATCL that is remarkable for its fulminant course and invasion of both kidneys manifested as acute renal failure. The patient was a 23 year old woman with a long history of celiac disease. She was presented with acute renal failure and enlarged mono-nuclear infiltrated kidneys. Diagnosis of tubuloi-nterstitial nephritis and polyserositis was confirmed with consecutive pulse doses of steroid therapy. After reco-very, she had disseminated disease two months later. Magnetic resonance imaging showed thickened intestine wall, extremely augmented kidneys, enlarged intra-abdominal lymph nodes with extra-luminal compression of common bile duct. Laparotomy with mesenterial adipous tissue and lymph glands biopsy was done. Consecutive pathophysiological and immunohistochemical analyses confirmed the diagnosis of EATCL: CD45RO , CD43 , CD3 . The revision of renal pathophysiology sub-stanti-ated the diagnosis. The patient received chemotherapy, but unfortunately she died manifesting signs of pulmonary embolism caused by tumor cells.     

A rare case of enteropathy-associated T-cell Iymphoma presenting as acute renal failure

Enteropathy-associated T-cell lymphoma (EATCL) is a high grade, pleomorphic peripheral T-cell lymphoma usually with cytotoxic phenotypes. We describe a first case of patient with EATCL that is remarkable for its fulminant course and invasion of both kidneys manifested as acute renal failure. The patient was a 23 year old woman with a long history of celiac disease. She was presented with acute renal failure and enlarged mononuclear infiltrated kidneys. Diagnosis of tubuloi-nterstitial nephritis and polyserositis was confirmed with consecutive pulse doses of steroid therapy. After reco-very, she had disseminated disease two months later. Magnetic resonance imaging showed thickened intestine wall, extremely augmented kidneys, enlarged intra-abdominal lymph nodes with extra-luminal compression of common bile duct. Laparotomy with mesenterial adipous tissue and lymph glands biopsy was done. Consecutive pathophysiological and immunohistochemical analyses confirmed the diagnosis of EATCL: CD45RO+, CD43+,CD3+. The revision of renal pathophysiology sub-stantiated the diagnosis. The patient received chemotherapy,but unfortunately she died manifesting signs of pulmonary embolism caused by tumor cells.     

Rhabdomyolysis

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle causing myoglobin and other intracellular proteins and electrolytes to leak into the circulation. The development of rhabdomyolysis is associated with a wide variety of diseases, injuries, medications and toxins. While the exact mechanisms responsible for all the causes are not fully understood, it is clear that muscle damage can occur from direct injury or by metabolic inequalities between energy consumption and energy production. Rhabdomyolysis is diagnosed by elevations in serum creatine phosphokinase (CPK), and while there is no established serum level cut-off, many clinicians use five times the upper limit of normal (∼1000 U/l). Rhabdomyolysis can be complicated by acute renal failure (occurring in 4–33% of patients), compartment syndrome, cardiac dysrhythmias via electrolyte abnormalities, and disseminated intravascular coagulopathy. The mainstay of treatment is hospitalisation with aggressive intravenous fluid (IVF) resuscitation with the correction/prevention of electrolyte abnormalities. There are additional adjunctive therapies to IVF, such as alkalinisation of the urine with sodium bicarbonate, diuretic therapy or combinations of both; however the lack of large randomised control studies concerning the benefits of these treatments makes it difficult to make strong recommendations for or against their use in the treatment of rhabdomyolysis. Regardless of these controversies, the overall prognosis for rhabdomyolysis is favourable when treated with early and aggressive IVF resuscitation, and full recovery of renal function is common. Irrespective of the cause of rhabdomyolysis the mortality rate may still be as high as 8%. This is a comprehensive review of the pathophysiology, diagnosis, complications and treatment options for rhabdomyolysis.     

BIOPSY PROVEN ACUTE TUBULAR NECROSIS DUE TO RHABDOMYOLYSIS IN A DENGUE FEVER PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.     

A lethal complication of propofol

High-dose propofol infusion for sedation of patients in the intensive care unit can result in rhabdomyolysis, acute renal failure, metabolic acidosis, hyperkalemia, ventricular arrhythmia, hyperthermia, and death. The death of a patient with such complications after lung biopsy is reported. Until a safer dosage range has been determined, propofol infusion at rates higher than 5 mg x kg(-1) x h(-1) should be discouraged for long-term sedation (> 48 h).     

Cortical blindness after coronary angiography: A rare but reversible complication

Transient cortical blindness is a recognized complication after vertebral and cerebral angiography but is a rare event after cardiac angiography. The development of cortical blindness appears to be an adverse reaction to the contrast agent which results in an osmotic disruption of the blood-brain barrier which appears to be selective for the occipital cortex. Patient outcome appears to be generally favorable with return of vision within 24–48 hr. This study describes three patients who had transient cortical blindness after cardiac catheterization and reviews what is known about this unusual problem.     

257例儿童急、慢性肾功能衰竭的病因分析

目的 :了解儿童急、慢性肾功能衰竭的常见病因及构成比例。方法 :回顾分析近十年间 2 5 7例住院儿童急、慢性肾功能衰竭的临床资料 ,以及部分肾组织病理结果。结果 :急性肾功能衰竭(ARF)占住院病例总数的 8.0 2 %,慢性肾功能衰竭 (CRF)占 2 .0 3%;ARF病例以急性肾小球肾炎最为常见 ,占 5 9.0 2 %;CRF病例以肾髓质囊性病最为常见 ,占 32 .6 9%。结论 :儿童急、慢性肾功能衰竭病因的构成比例与现有的文献资料有差异 ,反映了本地区儿童肾功能衰竭有关病因的分布状况。     

Spontaneous retroperitoneal and rectus muscle hemorrhage as a potentially lethal complication of cirrhosis.

AIMS/BACKGROUND: Cirrhosis may be complicated by bleeding from varices at sites of porto-systemic anastomosis and may be exacerbated by coagulopathy. METHODS: We describe two cases with decompensated cirrhosis who developed spontaneous retroperitoneal hemorrhage, with rectus sheath hematoma additionally in one case. RESULTS: The diagnosis was readily made by physical examination as both patients had Grey Turner's sign - ecchymosis of the flank. In addition, non-contrast computed tomography was very useful in confirming the diagnosis. The hemorrhage in both patients was associated with the coagulopathy typical of liver disease. However, one patient had features of disseminated intravascular coagulation initially while the other developed this complication during the course of the illness. Both patients died despite vigorous efforts to correct the coagulopathy together with surgical exploration in one case and angiography in the other. CONCLUSIONS: We speculate that the hemorrhage may have originated from varices within the retroperitoneum and abdominal wall, as both patients had significant hypertension. This suggests that variceal decompression may be useful in the management of such cases in the future.     

A rare and lethal complication of external collecting device for neuropathic voiding dysfunction--a case report

We present a rare and severe complication of condom. A 78-year-old man of dementia and neuropathic voiding dysfunction were sent to our Emergency Room due to loss of consciousness. Preliminary examinations showed only tachycardia and hypotension that revealed a condition of septic shock. The abnormal laboratory examinations revealed leukocytosis and deteriorated liver and renal function. Urinalysis was unable to be collected at emergency room because it was difficult to indwell the Foley catheter. The penis looked more than twice normal length. Strong parenteral antibiotics were given after blood culturing with removal of the condom. After debridement, the catheterization was successful. The circumcised wound healed gradually post-operation. However, he died 5 days later because of his severe urosepsis.     

以少见表现为首发症状的9例嗜铬细胞瘤临床分析

目的：探讨以少见表现为首发症状的的嗜铬细胞瘤的临床特点.方法：回顾性分析经手术病理证实为嗜铬细胞瘤并具有特殊临床表现的9例患者的临床资料结果：2例患者术前诊断为急性冠脉综合征;2例患者术前诊断休克;1例患者术前诊断为糖尿病酮症酸中毒;4例患者术前诊断为视神经炎.所有患者均有高血压.影像学检查均发现肾上腺占位病变,均经手术病理证实为肾上腺嗜铬细胞瘤,术后症状好转.结论：嗜铬细胞瘤表现多样化,高血压是重要的诊断线索,实验室及影像学检查对明确诊断有重要意义.     

Spontaneous liver rupture in hypereosinophilic syndrome： A rare but fatal complication

We report a rare case of spontaneous liver rupture in a patient with hypereosinophilic syndrome (HES), of which the diagnosis was delayed, resulting in a fatal outcome. The diagnostic criteria and treatment of HES with hepatic involvement were reviewed. The possible cause of spontaneous liver rupture in HES and its management were also discussed. To our knowledge, this is the first case report of spontaneous liver rupture in HES. We emphasized the need of a high index of suspicion in diagnosing HES, so that early treatment could be initiated.