Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin

Intraperitoneal (IP) vancomycin is widely used to treat Gram-positive peritonitis associated with peritoneal dialysis. There have been two cases of red man syndrome (RMS), a vancomycin-specific nonimmunologic reaction, associated with IP vancomycin. However, immune-mediated hypersensitivity reaction to IP vancomycin has not yet been reported. A 49 year old woman on continuous ambulatory peritoneal dialysis developed her first peritonitis episode. The patient was treated with IP vancomycin once/wk for 4 weeks. She experienced mild itching and flushing throughout her body for 1 day after the second treatment. Whenever vancomycin was administered, generalized urticaria and a prickling sensation developed, and the intensity increased gradually; however, these symptoms improved after vancomycin was discontinued. An allergic skin test was performed 6 weeks after the previous urticarial episode, and an intradermal skin test revealed a positive response to vancomycin. To our knowledge, this is the first case report of immunoglobulin E-mediated hypersensitivity reaction to IP vancomycin administration.

Incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis patient / 영남의대학술지

Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.

Obstructive uropathy after inguinal herniorrhaphy with a mesh in a renal transplant patient

A 67-year-old male renal transplant patient presented with a right inguinal bulging mass, and was diagnosed with a right indirect inguinal hernia. The day following inguinal herniorrhaphy, serum creatinine became elevated. The patient was oliguric and had abdominal pain on the first day after inguinal herniorrhaphy with a mesh. We diagnosed him with acute renal failure and subsequently performed acute hemodialysis. The kidney computed tomography showed hydronephroureter, with distal ureter obstruction. With urgent percutaneous nephrostomy, we were able to relieve the obstructive uropathy with distal ureteral stenosis. Subsequently, hernia repair was performed with removal of the mesh, followed by the antegrade ureteral stent insertion. Renal function was recovered after ureteral stent insertion. This case shows that acute renal failure can occur due to ureteral obstruction, complicated by an inguinal hernia repair, and this can be successfully treated with percutaneous nephrostomy and inguinal hernia repair with mesh removal.

Toxoplasmosis after Kidney Transplantation / 대한이식학회지

Toxoplasmosis is an infection caused by Toxoplasma gondii. It can be lethal in immunocompromised hosts, such as a transplant recipients or patients infected with human immunodeficiency virus. In solid organ transplant recipients, toxoplasmosis results mainly from transmission of the parasite with an allograft in cases of serological mismatch. Toxoplasmosis in an immunocompromised host is associated with high mortality. Thus, early diagnosis and treatment is very important. We report on a case of toxoplasmosis in a 51-year-old male patient who had undergone deceased donor kidney transplantation. He suffered from fever of unknown origin. He was finally diagnosed with toxoplasmosis, and treated successfully with trimethoprim-sulphamethoxazole.

A Case of Idiopathic Collapsing Glomerulopathy Showing Aggravation on a Chronic Progressive Course / 영남의대학술지

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus (HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.