Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient

Emphysematous pyelonephritis (EPN) is a life-threatening infection characterized by the formation of gas. Complications of EPN include septic shock, acute renal failure, and disseminated intravascular coagulation. Spontaneous subcapsular hematoma (SCH) has also been reported as a rare complication of EPN, although there have been no reports to date of this occurring prior to the presentation of EPN. We report a case of EPN that initially presented as spontaneous SCH. The patient was admitted for left flank pain, and initial computed tomography revealed SCH without any air shadows. Laboratory findings and clinical symptoms suggested the presence of urinary tract infection and the patient was started on antibiotics. Fever developed 24 hours after admission. On follow-up computed tomography 7 days later, EPN was newly observed, and a percutaneous drain was inserted. Blood, urine, and drainage fluid cultures all revealed growth of extended-spectrum beta-lactamase-negative Escherichia coli.

Skeletal Muscle Metastases from Breast Cancer: Two Case Reports / 한국유방암학회지

The skeletal muscle is an unusual site for metastasis from breast cancer. We present two cases of breast cancer that relapsed as skeletal muscle metastasis without other distant organ metastasis. We performed the core needle biopsy of metastatic sites and confirmed discordance in estrogen receptor, progesterone receptors, and human epidermal growth factor receptor 2 expression between primary breast cancer and skeletal muscle metastases. In the second case, we found the skeletal muscle metastasis through F-18 fluorodeoxyglucose positron emission tomography/computed tomography scans (PET/CT). Intramuscular hot spots on PET/CT scans should be considered as a sign of metastasis even in the absence of abnormalities on computed tomography scans. Our patients received systemic chemotherapy, and showed a partial response. Further studies are needed to determine the prognosis and proper management of isolated skeletal muscle metastasis in breast cancer.

Risk Factors and the Clinical Course of Acute Kidney Injury in Patients with a Femoral Fracture / 대한내과학회지

BACKGROUND/AIMS: Femoral fracture occurs most often in elderly patients and is highly associated with medical problems such as acute kidney injury (AKI); however no reports of AKI in femoral fracture patients have been published. This study was performed to identify risk factors and the clinical course of AKI in patients with femoral fracture. METHODS: We retrospectively evaluated the medical records of 110 patients with femoral fracture between November 2006 and December 2011 at Uijeongbu St. Mary's Hospital. We investigated the incidence and clinical course of AKI in femoral fracture patients and compared the clinical findings between AKI and normal kidney function (NKF) groups. RESULTS: Of the 110 femoral fracture patients, AKI was observed in 19 (17.3%). The peak serum creatinine level in patients with AKI was 2.59 +/- 1.57 mg/dL. Two of 19 patients with AKI died and two progressed to chronic kidney disease. When compared to the NKF group, the AKI group had a higher incidence of elevated lactate dehydrogenase (LDH) (63.2% vs. 34.1%, p = 0.020), erythrocyte sedimentation rate (ESR) (31.6% vs. 6.6%, p = 0.008), and C-reactive protein (57.9% vs. 46.2%, p = 0.042). The AKI group also had a longer hospitalization duration, and more patients were prescribed an angiotensin-converting-enzyme (ACE) inhibitor than in the NKF group. Multivariate analysis demonstrated elevated LDH, ESR and ACE inhibitor prescriptions as independent risk factors for AKI in patients with a femoral fracture. CONCLUSIONS: The incidence of AKI in patients with a femoral fracture was 17.3%, and AKI was associated with a longer clinical course. We recommend monitoring of laboratory findings and medications and early management to reduce the morbidity of patients with AKI.