A Case of Phenothiazine-induced Torsades de Pointes / 대한내과학회지

Torsades de pointes (TdP) is a form of polymorphic ventricular tachycardia associated with a prolonged QT interval or increased U wave. It may occur either in the congenital(idiopathic) form or in the aquired form. Although aquired TdP could be found in many clinical settings such as various drugs, bradycardia, or electrolyte imbalance, it is most commonly induced by drugs. The underlying mechanism is though to be the triggered activity arising as a consequence of early afterdepolarization. Phenothiazine has many derivatives that can lead to occur the cardiovascular events including hypotension, syncope, tachycardia and various ECG changes. Chloropromazine is a propylamine derivative of phenothiazine. We report a case of TdP occurred after chloropromazine usual dosage.

A Case of Primary Systemic Amyloidosis Predominantly Presenting Nephrotic Syndrome and Peripheral Neuropathy / 대한신장학회잡지

Primary systemic amyloidosis is a progressive disease that is frequently fatal. Nephrotic syndrome is present in almost one-third, congestive heart failure in one-quarter, and peripheral neuropathy in one-sixth of patients at the time of diagnosis. If heart or renal failure are presented, survival rate is poor. We experienced a case of a 66 year-old female patient who had complained lower leg edema and paresthesia of extremities for about 5 months. The laboratory findings were consistent with nephrotic syndrome, but the lower leg edema was non-pitting and the cause of paresthesia was unknown. We performed kidney and nerve biopsy and confirmed a case of primary systemic amyloidosis. In this case, presence of postural hypotension, probable cardiac involvement and relatively long spikes along the outside of the glomerular capillary loops on methenamine silver stain is suggestive of poor prognosis. We can predict chronic renal failure and congestive heart failure in the course of this case. We report a case of primary systemic amyloidosis predominantly presenting nephrotic syndrome and peripheral neuropathy with review of related literatures.