Severe Hypophosphatemia-Induced Acute Toxic-Metabolic Encephalopathy in Continuous Renal Replacement Therapy

Acute toxic-metabolic encephalopathy (TME) is an acute condition of global cerebral dysfunction in the absence of primary structural brain disease. Severe hypophosphatemia leads to muscle weakness and involves the diaphragm but hypophosphatemia-induced TME is very rare. Herein, we report the case of a 43-year-old woman with encephalopathy with severe hypophosphatemia during continuous renal replacement therapy. She presented with features of oliguric acute kidney injury on diabetic kidney disease due to volume depletion. At admission, her mental status was alert but gradually changed to stupor mentation during continuous renal replacement therapy. Her phosphate level was less than 0.41 mEq/L and Glasgow coma scale decreased from 15 to 5. After phosphate intravenous replacement and administration of phosphate-containing replacement solution, the phosphate level increased to 2.97 mEq/L and mental state returned to alert state. This case demonstrates that the level of phosphorus should be observed during continuous renal replacement therapy.

Successful Treatment of Invasive Gastric Mucormycosis in a Kidney Transplant Recipient / 대한이식학회지

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.

Chikungunya Virus Infection after Traveling to Surinam, South America / 대한내과학회지

Chikungunya infection is caused by an arbovirus transmitted by the Aedes mosquito. A 19-year-old man who had traveled to the Republic of Surinam to perform volunteer work complained of a fever, arthralgia, articular stiffness, and a skin rash on both the arm and trunk. Chikungunya fever was diagnosed using a Chikungunya virus specific IgM antibody in an enzyme-linked immunosorbent assay (ELISA) using blood samples obtained during follow-up visits. In this report, we describe a case of imported Chikungunya fever that presented with arthralgia and a skin rash, with islands of normal skin, that occurred following travel to Surinam, South America.

Cyclophosphamide therapy for secondary amyloidosis in a patient with juvenile idiopathic arthritis unresponsive to tumor necrosis factor α inhibitor therapy

No abstract available.

Colonic Mucormycosis Mimicking Ischemic Colitis in Kidney Transplant Recipient / 대한이식학회지

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Mucormycosis of the gastrointestinal tract manifests with features similar to ischemic colitis. A 48-year-old man with end-stage renal disease due to diabetic nephropathy underwent deceased donor kidney transplantation. He complained of abdominal pain and distension on postoperative day 17. A computed tomography (CT) scan revealed symmetrical wall thickening of the ascending colon, which was consistent with ischemic colitis. However, a follow-up CT scan showed a localized wall-off colon perforation in the hepatic flexure and segmental mural gas in the ascending colon. Microscopic examination obtained from a surgical specimen demonstrated numerous fungal hyphae and spores in the mucosa and submucosa. A total colectomy was performed, but the patient died 36 days later due to multiple organ failure, despite antifungal agents. Clinicians should be informed about fungal infection, such as colonic mucormycosis mimicking ischemic colitis, in kidney transplant patients with diabetes mellitus, and treatment should be initiated at the earliest.

A Case of Methomyl-induced Acute Allergic Tubulointerstitial Nephritis

Drug-induced interstitial nephritis is one of the causes of acute kidney injury. Although methomyl is widely used as an insecticide in many countries, methomyl-induced interstitial nephritis has not been reported thus far in the general population. We report a case of a 39-year-old male patient with acute allergic tubulointerstitial nephritis due to methomyl intoxication. He took methomyl 250 mL to commit suicide. He was treated with hemodialysis, but his renal function continued to deteriorate. Kidney biopsy demonstrated mononuclear cell and some eosinophils infiltration into the renal interstitium with tubular invasion. Immediate steroid pulse therapy, appropriate education, and conservative management resulted in gradual restoration of his renal function. This case suggests that methomyl may be a causative allergen inducing acute interstitial nephritis in some patients.

E-cadherin and beta-catenin Expression and Mutation in Gastric Carcinomas

PURPOSE: When cancer cels invade the stroma, they should be dissociated from the adjacent cells at first. E-cadherin and beta-catenin constitute an important protein complex associated with cellular adhesion, development, and differentiation, especially in epithelial cells.The role of E-cadherin and beta- catenin in gastric carcinogenesis were studied. MATENRIALS AND METHODS: The expression of E-cadherin and beta-catenin in gastric adenocarcinomas by using immunohistochemical staining and the mutation by using polymerase chain reaction- single stranded conformation polymorphism (PCR-SSCP) and sequencing were performed in 40 adenocarcinomas and 5 dysplasia of stomach. Thirteen cases, which had lymph node metastasis, were also included for immunohistochemical staining. RESULTS: Inappropriate cytoplasmic and/or nuclear expression of a E-cadherin-beta-catenin complex was more frequent in poorly differentiated, diffuse type signet ring cell carcinomas than in well-differentiated, intestinal type adenocarcinomas (P<0.05). However, the expression was not related with clinical stage or lymph node metastasis. Mutation of E-cadherin was detected in 4 cases by using PCR-SSCP, whereas mutation of beta-catenin was detected in 2 cases. CONCLUSION: E-cadherin and beta-catenin seem to be important in gastric carcinogenesis, especially in poorly differentiated diffuse type.