Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Associated with Mediastinal Schwannoma

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma

Post-transplant Lymphoproliferative Disorder in Transplanted Kidney Causing Urinary Tract Obstruction / 대한이식학회지

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication resulting in mortality and renal graft failure. PTLD is a heterogeneous disorder, which causes different clinical forms of disease from non-specific viral syndrome to malignant lymphoma and has various etiologies, clinical features, and treatment strategies. Here, we report on a patient who had a PTLD in the hilum of a transplanted kidney at 5 months after renal transplantation. The PTLD resulted in hydronephrosis of the transplanted kidney and graft dysfunction by local urinary tract obstruction. Despite treatment including immunosuppression reduction and rituximab administration, we removed the transplanted kidney from the recipient because the PTLD did not respond to the therapy.

Erythema Elevatum Diutinum in Human Immunodeficiency Virus Infected Patient

Erythema elevatum diutinum (EED) is emerging as a specific HIV-associated dermatosis which can be easily misdiagnosed as Kaposi's sarcoma or bacillary angiomatosis. Until now, no case of HIV-associated EED had been reported in Korea. We report a case of EED in a 49-year-old man with HIV infection. The patient was diagnosed with HIV-infection and treated with a combination of anti-retroviral agents and dapsone. Two years after the start of treatment the lesion had regressed.

Membranoproliferative Glomerulonephritis Associated with Papillary Thyroid Carcinoma / 대한신장학회지

Malignant tumors have been shown to be a major secondary cause of nephrotic syndrome. They have been associated with different glomerulopathy depending on their type. Membranoproliferative glomerulonephritis (MPGN) rarely develops in solid tumors, although cases have been reported in renal cell cancer, melanoma, lung cancer, and tumors in the urogenital system. However, to our knowledge, there have been no case reported of MPGN associated with thyroid cancer. In the present case, we observed MPGN associated with thyroid cancer in a 44-year-old woman with nephrotic syndrome and renal insufficiency. Her thyroid ultrasound revealed a tumor measuring 1.01x1.14x1.48 cm with an indistinct border that was partially calcified. The tumor was confirmed to be papillary carcinoma by percutaneous needle aspiration biopsy. Renal biopsy showed chronic tubulointerstitial nephritis and MPGN. On day 45 of admission, total thyroidectomy and neck lymphadenectomy were performed. After total thyroidectomy, serum total protein, albumin, C3, and C4 normalized. In conclusion, this case represents the first report of simultaneous development of MPGN and thyroid cancer.

A Fatal Case of Acute Superior Vena Cava Syndrome and Mediastinal Hematoma Following Insertion of the Internal Jugular Catheter for Hemodialysis / 대한신장학회지

The superior vena cava (SVC) syndrome refers to all clinical phenomena appeared as bronchial pneumonia, lymphoma, mediastinitis, and aortic aneurysm compress the superior vena cava and the veins in the vicinity in the superior mediastinum. Iatrogenic superior vena cava syndrome due to vascular stenosis or aneurysmal change has occurred by the repeated placement of cardiac pacemaker. Cardiac tamponade and hematoma have been reported in patients with end-stage renal disease due to impairment of blood coagulation caused by uremia. But acutely developed SVC syndrome was not reported after catheterization. In this report, we describe a case of acute SVC syndrome and mediastinal hematoma after insertion of internal jugular catheter for hemodialysis.

A Case of Renal Salt Wasting Syndrome Induced by Cisplatin for Chemotherapy / 대한신장학회지

Cisplatin is widely used for chemotherapy, but known to cause renal, auditory, hematologic, gastrointestinal, and neurologic toxicities. Hyponatremia after administration of cisplatin is related to renal tubular sodium excretion. A 71-year-old female was referred to our hospital for chemotherapy of laryngeal cancer. On admission, the patient's laboratory data were normal. The patient received for 3 days chemotherapy without complication, but presented mental confusion on the 4th hospital day. The laboratory findings were as follows; serum sodium was 118 mmol/L, urine sodium 163 mmol/L, serum osmolality 248 mmol/kg, and urine osmolality 594 mmol/kg. On physical exam, volume status was hypovolemic, so we supplied hypertonic and isotonic salines. On the 9th hospital day, she showed normal sodium concentration and clear consciousness. After chemotherapy, we should make differential diagnosis between SIADH (syndrome of inappropriate antidiuretic hormone) and renal salt wasting syndrome according to the physical examination. We report a case of renal salt wasting syndrome with severe mental change after chemotherapy using cisplatin.

A Case of Nocardia farcinica Brain Abscess in a Focal Segmental Glomerulosclerosis Patient after Steroid Treatment / 대한신장학회지

Nocardia is an opportunistic pathogen that can cause disseminated disease in serious immunosuppressive patients with organ transplantation, advanced HIV infection, malignancy or long-term corticosteroid use. Cerebral nocardiosis constitutes the most severe form of Nocardial infection. Early detection and treatment of cerebral abscess of Nocardia is important because the mortality is three times higher than that of other bacterial cerebral abscesses. We report a case of N. farcinica brain abscess in a focal segmental glomerulosclerosis (FSGS) patient after steroid treatment.

A Case of Rhabdomyolysis and Acute Renal Failure Associated with Salmonella Enteritidis / 대한신장학회지

Rhabdomyolysis varies from transient elevation of muscular enzyme to reduction of circulating volume and development of acute kidney injury (AKI). The majority is related to trauma, excessive exercise, alcohol and seizure disorders. Systemic infections associated with salmonellosis were rarely reported. Most of Salmonella infections are caused by Salmonella Typhi. Most common manifestations are typhoid fever and gastroenteritis. Sometimes serious complications such as gastrointestinal bleeding, intestinal perforation, and encephalopathy occur. However, AKI-associated rhabdomyolysis is rarely reported in salmonellosis even though it is not considered to be a major complication. Unfortunately, the precise pathogenetic mechanisms responsible for rhabdomyolysis with Salmonella Enteritidis infection are poorly understood due to the rarity of reported cases. In this presentation, we describe a patient with Salmonella Enteritidis (serogroup D) bacteremia complicated by disseminated intravascular coagulation, rhabdomyolysis and AKI. The blood culture and stool culture from the patient yielded Salmonella Enteritidis. Rhabdomyolysis and AKI should be considered as potentially fatal complications in patients with Salmonella Enteritidis infection.