A case of scrub typhus requiring maintenance hemodialysis

Renal failure caused by scrub typhus is known to be reversible. In most cases, renal function is almost fully restored after appropriate antibiotic treatment. A 71-year-old man was diagnosed with scrub typhus complicated by renal failure. A renal biopsy revealed histopathologic findings consistent with acute tubulointerstitial nephritis. Renal function did not improve 18 months after discharge and the patient required continuous hemodialysis. Although severe renal failure requiring dialysis is a rare complication of scrub typhus, we describe a case of scrub typhus requiring maintenance hemodialysis. To the best of our knowledge, this is the first such report.

The Effect of Antiplatelet Agent on Platelet Function in End-stage Renal Disease

OBJECTIVE: Uremic bleeding is well recognized problem. In patients with renal failure, the safety of antiplatelet therapy is doubtful and there is little data about the platelet function in dialysis patients who are prescribed antiplatelet agents. The aim of this study is to investigate the platelet function in dialysis patients who were taking antiplatelet agents. METHODS: The cross-sectional study was performed on 49 patients who have been undergoing dialysis (A group, 19 patients), normal renal function (B group, 30 patients). All of them have taken aspirin and clopidogrel. The control group (C group) consisted of 30 patients who have been undergoing dialysis, not taking aspirin or clopidogrel. The in-vitro closure time was measured using a PFA-100 device that had cartridges holding a membrane with a central aperture and this was coated with either collagen/epinephrine (CEPI) or collagen/adenosine diphosphate (CADP). In vitro closure time was measured by each cartridge defined CADP and CEPI. RESULTS: The CADP and CEPI were higher in the patients with end stage renal disease (ESRD) and who were not taking dual blockers than the normal range (CADP: 80-162, CEPI: 64-121). CADP prolonged in A group compared to C group. Hemodialysis, platelet count <201x106/L, hematocrit, antiplatelet medication are relevant to the prolongation of CEPI and CADP in binary logistic regression analyses. CONCLUSION: Platelet function in ESRD patients was deteriorated irrespective of antiplatelet medication, which became even worse if they took antiplatelet drugs. Therefore, we have to take careful attention to the increased bleeding tendency of ESRD patients due to the antiplatelet drugs.

A Case of Systemic Amyloidosis Found by Goiter in Crohn's Disease

Secondary amyloidosis is characterized by accumulation of insoluble, fibrous amyloid proteins in various tissues and organs, accompanied by infectious or inflammatory diseases. Amyloidosis may involve the thyroid, gastrointestinal tract, kidneys, liver, or bone marrow. Amyloidosis as a complication of Crohn's disease is rare but serious, and may worsen the prognosis. We have experienced a case of amyloid goiter and gastrointestinal amyloidosis secondary to Crohn's disease. A 74-year-old female patient with Crohn's disease was admitted to Soonchunhyang University Hospital with general weakness and poor oral intake. Anterior-neck diffuse goiter and tenderness around the navel were found. Amyloid goiter and gastrointestinal amyloidosis diagnosed by sonoguided needle biopsy of the thyroid and endoscopic biopsies of the stomach and duodenum.

Airway Compression Caused by Bilateral Thyroid Hematoma after Fine-Needle Aspiration

Fine-needle aspiration (FNA) is considered the most accurate, cost-effective and relatively safe method in the evaluation of thyroid nodules and fatal complications after thyroid FNA are uncommon. In particular, the large hematomas after FNA causing airway compromise are extremely rare complications and were reported in only a few literatures. We reported a 51-year-old woman who showed airway compromise caused by bilateral intrathyroidal and perithyroidal hematoma after FNA of thyroid. A large thyroid hematoma after FNA is a rare but possible complication and sometimes can be fatal for the patient. Proper preventive efforts should be considered while performing thyroid FNA and prompt intervention is mandatory for patients with acute hematoma after FNA.

A Case of Acute Gastric Pneumatosis Associated with Advanced Pancreatic Cancer

Pneumatosis intestinalis (PI) is a rare condition that is characterized by multiple subserosal and submucosal gas-filled areas in the bowel wall. Gastric pneumatosis describes the presence of gas within the stomach wall. This is caused by a disruption in gastric mucosa leading to the dissection of air into the wall. The extract cause of PI is still unknown; however, it may be associated with coexisting disease. Gastric PI has been rarely documented. So, we report on a 75-year-old man with acute gastric pneumatosis following his palliative chemotherapy. He underwent 3rd cycle of gemcitabine and erlotinib 3 weeks prior to admission. The treatment was started with nasogastric tube insertion and parenteral nutrition. Then, gastric pneumatosis was improved. However, the patient was died because of worsening underline disease and general condition. We suggest that chemotherapy should be considered the case of pneumatosis and careful X-ray interpretation will be necessary for detecting the pneumatosis earlier.

Acute Fulminant Myocarditis Following Scrub Typhus Infection / 대한내과학회지

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus.