RESUMO
Diagnoses of pyelonephritis caused by Staphylococcus aureus should be accompanied by investigations of concomitant bladder obstruction and metastatic infections, especially to the spine or heart. Complicated pyelonephritis due to S. aureus requires more than 2 weeks of antibiotics, which is the typically recommended treatment duration for pyelonephritis. We describe a patient who was diagnosed with complicated epidural and paraspinal abscesses after insufficient evaluation and treatment of acute pyelonephritis due to S. aureus. A 62-year-old man with type 2 diabetes was admitted with fever, increased urinary frequency, and left flank pain. He was diagnosed with acute pyelonephritis caused by S. aureus. His fever and flank pain subsided after 3 days of intravenous antibiotics. Evaluation of bladder obstruction and metastatic infection were not performed, as he declined further evaluation. The patient was discharged with oral antibiotics and was requested to attend weekly appointments but was lost to follow-up. One month later, the patient presented at the outpatient clinic with similar symptoms. Computed tomography showed recurrent pyelonephritis and a distended bladder. His flank pain persisted despite administration of an opioid agent. Therefore, magnetic resonance imaging was performed, revealing epidural and paraspinal abscesses. Ultrasound-guided aspiration of the paraspinal muscle layer was performed, and blood and percutaneous aspirated fluid cultures revealed S. aureus growth. The pattern of antimicrobial sensitivity was identical to that at his first admission. Following more than 4 weeks of antibiotics, magnetic resonance imaging showed the abscesses had decreased in size. The patient was discharged without neurologic sequelae and was provided with oral antibiotics.
Assuntos
Humanos , Pessoa de Meia-Idade , Abscesso , Instituições de Assistência Ambulatorial , Antibacterianos , Agendamento de Consultas , Diagnóstico , Abscesso Epidural , Febre , Dor no Flanco , Coração , Perda de Seguimento , Imageamento por Ressonância Magnética , Músculos Paraespinais , Pielonefrite , Coluna Vertebral , Staphylococcus aureus , Staphylococcus , Bexiga Urinária , Infecções UrináriasRESUMO
A 59-year-old woman was admitted to our hospital with polydipsia and general weakness. She had a 30-year history of bipolar disorder and was being treated with risperidone (4 mg/day) and lithium carbonate (1,200 mg/day). During her time in hospital, her urine output and serum osmolality increased, and her urine osmolality decreased. She was found to have myoglobulinuria, an elevated creatine kinase level, and abnormal renal function. Based on these findings, the patient was diagnosed with diabetes insipidus and rhabdomyolysis secondary to lithium therapy. After fluid therapy and the withdrawal of lithium, her clinical symptoms improved significantly. Her urine volume decreased gradually after treatment with amiloride. The effects of lithium on the muscle system are unknown. Hyperosmolarity caused by lithium-induced diabetes insipidus is considered a contributing factor in rhabdomyolysis.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Amilorida , Transtorno Bipolar , Creatina Quinase , Diabetes Insípido , Diabetes Insípido Nefrogênico , Hidratação , Lítio , Carbonato de Lítio , Músculos , Concentração Osmolar , Polidipsia , Rabdomiólise , RisperidonaRESUMO
A 59-year-old woman was admitted to our hospital with polydipsia and general weakness. She had a 30-year history of bipolar disorder and was being treated with risperidone (4 mg/day) and lithium carbonate (1,200 mg/day). During her time in hospital, her urine output and serum osmolality increased, and her urine osmolality decreased. She was found to have myoglobulinuria, an elevated creatine kinase level, and abnormal renal function. Based on these findings, the patient was diagnosed with diabetes insipidus and rhabdomyolysis secondary to lithium therapy. After fluid therapy and the withdrawal of lithium, her clinical symptoms improved significantly. Her urine volume decreased gradually after treatment with amiloride. The effects of lithium on the muscle system are unknown. Hyperosmolarity caused by lithium-induced diabetes insipidus is considered a contributing factor in rhabdomyolysis.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Amilorida , Transtorno Bipolar , Creatina Quinase , Diabetes Insípido , Diabetes Insípido Nefrogênico , Hidratação , Lítio , Carbonato de Lítio , Músculos , Concentração Osmolar , Polidipsia , Rabdomiólise , RisperidonaRESUMO
Cyclosporine is an immunosuppressive agent that plays an important therapeutic role for organ transplantation. However, complications due to type 1 renal tubular acidosis, albeit rare, have been reported. We experienced a case of severe metabolic acidosis associated with cyclosporine administration after renal transplantation. A 54-year old man was hospitalized for seizure, confusion and weakness. He demonstrated severe metabolic acidosis and hypokalemia. Continuous renal replacement therapy was started and sodium bicarbonate was administered to correct the acidosis and the dosage of cyclosporine was reduced. Thereafter, the cyclosporine level in whole blood decreased gradually, and the metabolic acidosis improved.
Assuntos
Acidose , Acidose Tubular Renal , Ciclosporina , Hipopotassemia , Rim , Transplante de Rim , Transplante de Órgãos , Terapia de Substituição Renal , Convulsões , Bicarbonato de Sódio , TransplantesRESUMO
It has been reported that IgA nephropathy is associated with alcoholic liver cirrhosis. However, crescentic glomerulonephritis or nephrotic syndrome are relatively rare. We experienced a patient with IgA nephropathy complicated with alcoholic liver cirrhosis who showed favorable clinical outcomes through steroid treatment. A 54-year-old man with alcoholic liver cirrhosis was hospitalized for generalized edema, nephrotic-range proteinuria and azotemia. We performed a renal biopsy and crescentic formations were found in half of the glomeruli. After use of steroid, azotemia and proteinuria improved gradually.