Plasma cell-rich acute rejection after renal transplantation in a patient with pyoderma gangrenosum: a case report.

A 40-yr-old female received a living-related renal transplantation on January 29, 2008. She had type I diabetes mellitus and pyoderma gangrenosum (PG). Induction immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil, basiliximab, and prednisolone. Intravenous methylprednisolone pulse therapy was administered to prevent ulceration at the surgical site. The postoperative outcome was almost uneventful, and renal graft function was well preserved for 11 months. Her graft function deteriorated on December 24, 2008 and thus an episode biopsy was performed. The histopathological findings were consistent with plasma cell-rich acute rejection (PCAR). During hospitalization, it was noted that the patient was non-compliant. We then performed steroid pulse therapy, and her graft function and histological findings improved. This is the first report of PCAR in a patient with PG who received a renal allograft. It was thought that PCAR was triggered because of her non-compliance. Thus, we should recognize the importance of enhancing compliance in transplant recipients.

Hemosuccus pancreaticus caused by rupture of a true splenic artery aneurysm following a failure of coil embolization.

Hemosuccus pancreaticus, particularly that caused by a primary aneurysm, is rarely encountered. Thus, its clinical characteristics are not well known. We report the case of a 53-year old man, who presented with hemosuccus pancreaticus caused by the rupture of an atherosclerotic aneurysm of the splenic artery and underwent distal pancreatectomy with splenectomy. Only 16 cases of hemosuccus pancreaticus due to primary aneurysm have previously been reported in the English-language literature between 1970 and 2003. The relevant literature was also reviewed. The review of the literature showed that because diagnosis is difficult to establish due to intermittent hemorrhage, a long time was often taken before definitive treatment was instituted. Treatment based on a definitive or suspected diagnosis reached a satisfactory result; however, the condition can cause a life-threatening situation. When upper gastrointestinal bleeding from an obscure source is encountered, hemosuccus pancreaticus should be considered. We suggest that when an aneurysm of peripancreatic vessels is present, adequate treatment for the aneurysm should be immediately undertaken, even though the site of the bleeding has not been confirmed.

Buerger's disease in a 19-year-old woman.

A 19-year-old female college student had numbness and the sensation of coldness of her left toes. She had a 3-year smoking history. Gangrene of the left foot developed rapidly. Angiography revealed peripheral arterial occlusion of both legs and arms. Detailed laboratory examination excluded collagen disease, a hypercoagulable state, and juvenile atherosclerosis. Below-knee amputation of the left leg was performed. Typical histologic findings of Buerger's disease were observed in the crural arteries and saphenous veins. The clinical course was uneventful after the patient stopped smoking. This is the second case report of Buerger's disease in a woman in the second decade of life. It is important that a correct diagnosis of Buerger's disease be established, because the disease process is benign, compared with collagen disease, if the patient stops smoking.