RESUMO
Ifosfamide, a cytotoxic antineoplastic drug, can induce rare complications of Fanconi syndrome and nephrogenic diabetes insipidus (DI). Ifosfamide-induced Fanconi syndrome tends to occur in patients with certain risk factors including young age, high cumulative ifosfamide dose, and coadministration of cisplatin. Nephrogenic DI causes polyuria from impaired urinary concentrating ability due to resistance to arginine vasopressin (AVP) at the collecting duct. These complications are serious and potentially fatal. Here, we describe a case of a middle-aged man without risk factors who was admitted for the management of acute kidney injury and electrolyte derangements after his fourth cycle of chemotherapy including ifosfamide for synovial sarcoma. He was found to have hypokalemia, hypophosphatemia, renal glycosuria, and aminoaciduria, likely from Fanconi syndrome, which were managed by electrolyte replacement therapy. In addition, polyuria and hypernatremia were considered due to nephrogenic DI, which partially responded to desmopressin treatment. This case highlights the importance of the routine electrolytes monitoring after ifosfamide treatment.
Assuntos
Acetamidas/uso terapêutico , Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Daptomicina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina , Valva Mitral , Oxazolidinonas/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Acetamidas/efeitos adversos , Aminoglicosídeos/efeitos adversos , Antibacterianos/efeitos adversos , Ecocardiografia Transesofagiana , Endocardite Bacteriana/microbiologia , Humanos , Linezolida , Lipoglicopeptídeos , Imageamento por Ressonância Magnética , Masculino , Testes de Sensibilidade Microbiana , Oxazolidinonas/efeitos adversos , Paraparesia/etiologia , Infecções Estafilocócicas/microbiologia , Falha de TratamentoRESUMO
Calciphylaxis is a rare but potentially fatal condition occurring in patients with end stage renal disease on dialysis. Due to interplay of various factors, disturbances occur in the metabolism of calcium and phosphate leading to calcification within the vessel walls. The net result is tissue ischemia and necrosis. Clinically this presents as painful non-healing skin ulcers, which contribute to significant morbidity and mortality due to septic progression of the lesion. In this case report, we highlight the rapidly progressive nature of this disease, its etiopathogenesis and the role of early diagnosis in preventing life-threatening complications.
