Febuxostat for the Treatment of Chronic Tophaceous Gout in a Patient on Continuous Ambulatory Peritoneal Dialysis / 대한내과학회지

Hyperuricemic patients with gouty arthritis or tophi, a serum uric acid concentration of 8.0 mg/dL or higher, and complications should be treated with urate-lowering drugs. Conventionally, allopurinol is used to treat hyperuricemia and gout, but it is necessary to adjust the dosage according to the degree of renal impairment. Uncommonly, allopurinol may have severe or fatal side effects. The non-purine xanthine oxidase inhibitor febuxostat undergoes hepatic metabolism and may require less dose adjustment in association with renal function. It is considered to be an alternative treatment for hyperuricemic patients with chronic kidney disease. Our experience suggests that low-dose febuxostat is a promising alternative to allopurinol for the treatment of gouty arthritis or tophi in peritoneal dialysis patients.

Late Onset Infection of Pneumocystis jirovecii Infection in a Renal Transplant Recipient / 대한이식학회지

Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.

A Case of Squamous Cell Carcinoma in Nasal Cavity Treated with Conversion to Sirolimus in a Patient with Kidney Transplantation / 대한이식학회지

Conversion of immunosuppressants to sirolimus, an inhibitor of mammalian target of rapamycin, is a useful treatment option for prevention of the adverse events of immunosuppressants such as calcineurin inhibitor in renal transplantation recipients. In addition, sirolimus has been improving the quality of life and increasing the survival of patients with renal transplantation by decreasing immunosuppression-related malignancies, particularly skin cancer. However, complete remission of skin squamous cell carcinoma after renal transplantation only by conversion to sirolimus has not been well reported, although its preventive effect on skin cancer is well known. We report on a 72-year-old male with squamous cell carcinoma in his nasal cavity consequent to renal transplantation, which was treated completely with the conversion of cyclosporine to sirolimus without surgical removal or chemotherapy.