Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Actinomycosis ; Aged ; B-Lymphocytes ; Biopsy ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Masks ; Penicillin G ; Sulfur ; Tomography, X-Ray Computed ; Weight Loss

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Actinomycosis ; Aged ; B-Lymphocytes ; Biopsy ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Masks ; Penicillin G ; Sulfur ; Tomography, X-Ray Computed ; Weight Loss

Nutcracker syndrome (NCS) refers to left renal vein compression with impaired blood outflow. The etiology of NCS has been attributed to various anatomic anomalies. Posterior NCS is caused by compression of the retroaortic left renal vein between the aorta and spine. The classic symptoms of NCS include left flank pain with gross or microscopic hematuria. The frequency and severity of the syndrome vary from asymptomatic microhematuria to severe pelvic congestion. For this reason, diagnosis of NCS is difficult and often delayed. Here, we report a case of posterior NCS that was incidentally discovered.
Aorta ; Diagnosis ; Estrogens, Conjugated (USP) ; Flank Pain ; Hematuria ; Renal Veins ; Spine

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.
Acute Kidney Injury ; Adolescent ; Biopsy ; Blood Pressure ; Blood Urea Nitrogen ; Body Mass Index ; Child ; Creatinine ; Cystatin C ; Estrogens, Conjugated (USP) ; Flank Pain ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Cortex Necrosis ; Male ; Mortality ; Nausea ; Necrosis ; Nephritis ; Obesity ; Oliguria ; Perfusion ; Proteinuria ; Pyuria ; Vomiting

Ultrasonography is a useful tool for the differential diagnosis of acute flank pain. Renal stones appear as a focal area of echogenicity with acoustic shadowing on ultrasonography. In acute pyelonephritis (APN), the kidneys may be enlarged and have a hypoechoic parenchyma with loss of the normal corticomedullary junction. However, clinical and laboratory correlations are essential for the diagnosis of renal stones and APN through imaging studies. This review describes the typical ultrasonography features of renal stones and APN. Moreover, in daily practice, cross-sectional imaging is essential and widely used to confirm renal stones and APN and to differentiate them from other diseases causing flank pain. Other diseases causing acute flank pain are also described in this review.
Acoustics ; Diagnosis ; Diagnosis, Differential ; Flank Pain* ; Kidney ; Pyelonephritis* ; Shadowing (Histology) ; Ultrasonography* ; Urinary Calculi

PURPOSE: A case of frosted branch angiitis in Kikuchi-Fujimoto disease is reported. CASE SUMMARY: A 33-year-old male complained of a sudden decrease in visual acuity that developed in both eyes 5 days prior. He suffered from a headache, chills, myalgia, and flank pain 1 week before. The initial best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.2 in the left eye. On slit lamp examination, no inflammatory finding was observed in the anterior chamber and vitreous body of both eyes. On fundus examination, a diffuse vascular sheathing-like frosted branch was found in the retinal vessels, and retinal hemorrhage was observed. Fluorescein angiography showed staining and leakage of dye along the vascular sheathing. Serological findings were negative, showing no evidence of an autoimmune disease or viral infection. Neck ultrasonography revealed non-tender left cervical lymph node enlargement >1 cm in diameter. Ultrasound-guided fine needle aspiration cytology showed findings compatible with Kikuchi-Fujimoto disease, including necrotic changes and pronounced karyorrhexis, plus histiocyte and lymphocyte infiltration without neutrophils. We started systemic steroid therapy. One month after treatment, the BCVA of both eyes improved to 1.0. CONCLUSIONS: In patients with frosted branch angiitis, systemic disease such as Kikuchi-Fujimoto disease should be considered.
Adult ; Anterior Chamber ; Autoimmune Diseases ; Biopsy, Fine-Needle ; Chills ; Flank Pain ; Fluorescein Angiography ; Headache ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Lymph Nodes ; Lymphocytes ; Male ; Myalgia ; Neck ; Neutrophils ; Retinal Hemorrhage ; Retinal Vessels ; Slit Lamp ; Ultrasonography ; Vasculitis ; Visual Acuity ; Vitreous Body

Spontaneous and isolated dissection of the limb arteries without involvement of the aorta is extremely rare, and has been reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes. There is no consensus yet on indications for medical or surgical therapeutic modality. Due to the rarity of spontaneous dissection of external iliac artery, its natural history has been poorly described. A healthy 50-year-old male with normotension was admitted with an acute onset of left flank pain. Left external iliac artery dissection was diagnosed by abdominal computed tomography.
Aorta ; Arteries ; Athletes ; Collagen ; Consensus ; Extremities ; Flank Pain ; Humans ; Iliac Artery ; Male ; Middle Aged ; Natural History ; Stents ; Vascular Diseases

Ureteropelvic junction obstruction is one of the common causes of hydronephrosis in infancy and childhood. Most cases of ureteropelvic junction obstruction are diagnosed prenatally and are usually asymptomatic. Although less common, older children can experience ureteropelvic junction obstruction that presents with symptoms including flank or abdominal pain. Here, we present the case of a nine-year-old healthy girl who had repeated flank pain and abdominal symptoms, with mild left hydronephrosis, for several months. Computed tomography that was performed during the period of acute flank pain revealed aggravated hydronephrosis on her left kidney, which was secondary to an ureteropelvic junction obstruction. She underwent laparoscopic pyeloplasty, and a crossing vessel that passed the ureteropelvic junction was identified. In addition, we reviewed the current literature of this rare entity.
Abdominal Pain ; Child ; Female ; Flank Pain ; Humans ; Hydronephrosis ; Kidney ; Ureteral Diseases ; Ureteral Obstruction

Urolithiasis is suspected by flank pain, costovertebral angle tenderness, and hematuria, and confirmed by computed tomography (CT). Treatment strategy and likelihood of spontaneous passage of a stone were determined by size and position of ureteral calculi and complication detected by CT. In general, the purpose of urinalysis for urolithiasis is to confirm the hematuria and pyuria. However, sometimes albumin is detected by urine dipstick test in urolithiasis. Therefore, I performed this study to investigate the clinical significance of urine dipstick positive for albuminuria in urolithiasis. This study was a retrospective review of medical records of 150 patients who visited the emergency department and diagnosed with urolithiasis by CT between March 2010 and February 2014. The patients were divided into a albuminuria group and non-albuminuria group. General chracteristics, clinical features, laboratory results, and CT findings were compared. The incidence of stones >5 mm in diameter, hydronephrosis (≥grade 2) and upper ureter stone were significantly higher in albuminuria group than non-albuminuria group. In multivariate logistic regression analysis, hydronephrosis (≥grade 2) and upper ureter stone were significantly associated with albuminuria. Upper ureter stone and hydronephrosis (≥grade 2) are also known as predictors for failure of spontaneous passage of ureter calculi. If further studies are done, urine dipstick positive for albumin in urolithiasis can be used as a predictor for failure of spontaneous passage of ureter calculi.
Albuminuria* ; Calculi ; Emergency Service, Hospital ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Incidence ; Logistic Models ; Medical Records ; Pyuria ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Urinalysis ; Urolithiasis*

While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.
Aged ; Anti-Bacterial Agents ; Bacteremia ; Carbapenems ; Ciprofloxacin* ; Electrophoresis, Gel, Pulsed-Field ; Emergency Service, Hospital ; Escherichia coli* ; Escherichia* ; Female ; Fever ; Flank Pain ; Humans ; In Vitro Techniques ; Point Mutation ; Pyelonephritis* ; Serogroup ; Treatment Failure