POEMS syndrome misdiagnosed as bone metastasis in a patient with thyroid cancer / 영남의대학술지

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a monoclonal plasma cell disorder. Patients with POEMS syndrome also have various clinical manifestations including generalized edema, pleural effusion, ascites, papilledema, and sclerotic bone lesions. These manifestations can lead to a misdiagnosis or delayed diagnosis. We recently experienced a 51-year-old male patient with POEMS syndrome whose sclerotic bone lesion was misdiagnosed as malignant bone metastasis of papillary thyroid carcinoma. We reassessed the patient and found polyneuropathy, hepatosplenomegaly, hypothyroidism, partial hypopituitarism, immunoglobulin G lambda-type monoclonal gammopathy, hypertrichosis, ascites, and multiple sclerotic bone lesions, all of which led us to a diagnosis of POEMS syndrome. Treatment with thalidomide and dexamethasone resulted in clinical and radiological improvement. The patient has remained in remission after peripheral blood stem cell transplantation.

Renal Infarction in Antiphospholipid Antibody-negative Pediatric Systemic Lupus Erythematosus Patient

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems, and is characterized by the deposition of immune complexes and a large array of autoantibodies. Thrombosis is a relatively frequent and serious complication of SLE; however, renal infarction in young patients with antiphospholipid antibody-negative lupus has rarely been reported, and no pediatric case has been reported in Korea. A 12-year-old female patient was presented to our hospital with a 3-day history of nausea, vomiting, and right flank pain. She was diagnosed with SLE and lupus nephritis two years ago and was treated with corticosteroids and hydroxychloroquine, azathioprine. Abdominal computed tomography (CT) showed renal infarction in the upper pole of the right kidney. Subcutaneous low molecular weight heparin was started, and warfarin was also started simultaneously and continued for 3 months. After 3 months, only minimal atrophic changes were seen on the abdominal CT. She is doing well by maintaining oral anticoagulant therapy and is being followed up regularly through outpatient clinic visits.

Treatment of Endobronchial Hemorrhage Using Balloon Tamponade and Bronchial Artery Embolization / 계명의대학술지

Endobronchial hemorrhage is common complication of bronchoscopic biopsy. There are several hemostatic methods including cold saline irrigation, topical vasoactive substance instillation, tranexamic acid treatment, and balloon tamponade. Insertion of balloon catheter into bronchoscopic working channel is relatively simple and useful method for the selective hemostasis. Here, we report a case of 75-year-old female patient who had hemorrhage during endobronchial biopsy with flexible bronchoscopy. Since primary treatments such as cold saline irrigation and epinephrine instillation had been failed to stop hemorrhage, balloon catheter was immediately inserted into the bleeding site for temporal hemostasis. And then, bronchial artery embolization was followed for the additional treatment of hemorrhage. We suggest to use balloon catheter as a bridge therapy before bronchial artery embolization.

A Case of Primary Aldosteronism Accompanied by Hypokalemic Rhabdomyolysis / 영남의대학술지

Primary aldosteronism is characterized by hypertension, hypokalemia, and metabolic alkalosis, associated with excessive aldosterone production and suppressed plasma renin activity. Hypokalemia-induced rhabdomyolysis has been rarely reported in primary aldosteronism patients. This paper reports a case of primary aldosteronism presented with rhabdomyolysis due to severe hypokalemia. A 48-year-old male with a three-year history of hypertension presented himself at the authors' hospital with generalized weakness and myalgia in both legs over a period of several days. His laboratory findings showed hypokalemia (1.8 mEq/L) with elevations of his serum creatine phosphokinase and serum myoglobin. His plasma aldosterone level was also elevated, and his plasma renin activity was reduced. An abdominal computed tomography revealed a 2.0 cm hypodense mass in the left adrenal gland, which suggested adrenal adenoma. The accordingly underwent laparoscopic adrenalectomy. Three months later, his plasma potassium level and blood pressure became normal without the use of medications.