Posttransplant lymphoproliferative disorder (PTLD) is an uncommon but life-threatening complication of immunosuppressive therapy following solid organ transplantation. It encompasses a heterogeneous group of lymphoproliferative disorders ranging from reactive, polyclonal hyperplasia to aggressive non- Hodgkin's lymphoma. The majority of PTLD is of B-cell origin and associated with Epstein-Barr virus (EBV) infection. Gastrointestinal involvement, especially small bowel and colon, is common in patients with PTLD, but the duodenum is rarely involved. We have experienced a case of PTLD involving the duodenum eight years after kidney transplantation in 50-year-old man. Two weeks before admission, he had complained of epigastric pain, and was diagnosed as pangastritis and duodenal ulcer by upper gastrointestinal endoscopy. He was admitted due to aggravated epigastric pain despite anti-ulcer medication. On the seventh hospital day, we found a new mass-like lesion in the pyloric area of antrum and diffuse ulceration in the duodenum by follow-up endoscopy. Histologic findings revealed diffuse large B-cell lymphoma. During reduction in immunosuppressive regimens, his conditions deteriorated rapidly. He died of sepsis associated with duodenal ulcer perforation, 18 days after diagnosis.
B-Lymphocytes ; Colon ; Diagnosis ; Duodenal Ulcer ; Duodenum* ; Endoscopy ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Herpesvirus 4, Human ; Hodgkin Disease ; Humans ; Hyperplasia ; Kidney Transplantation* ; Kidney* ; Lymphoma, B-Cell ; Lymphoproliferative Disorders* ; Middle Aged ; Organ Transplantation ; Sepsis ; Transplants ; Ulcer

Peritonitis is one of the major complications of CAPD (continuous ambulatory peritoneal dialysis). Among its causative organisms, vancomycin-resistant enterococcus (VRE) is rare, but serious causative organism, because it is refractory to antibiotics commonly used for CAPD peritonitis. Some drugs such as linezolid and dalfopristin have been introduced for VRE infections nowadays, but reports about usefulness of those drugs in VRE peritonitis are rare. We experienced a case of CAPD peritonitis caused by VRE, which was treated successfully with removal of CAPD catheter and use of linezolid. We report our experience with review of the literature.
Anti-Bacterial Agents ; Catheters ; Enterococcus ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Linezolid

Spontaneous renal rupture with hemoperitoneum in patients receiving continuous ambulatory peritoneal dialysis (CAPD) is very rare. Hemoperitoneum in peritoneal dialysis patients is often attributed to mechanical, gynecological or intraperitoneal abdominal pathology. Few cases have been described with retroperitoneal bleeding in CAPD patients. Hence we report one case of spontaneous renal rupture with retroperitoneal hemorrhage and haemoperitoneum in a CAPD patient with acquired cystic kidney disease.
Hemoperitoneum* ; Hemorrhage ; Humans ; Kidney Diseases, Cystic ; Pathology ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Rupture* ; Rupture, Spontaneous

Aneurysm of the carotid artery is an uncommon clinical disease which can occur as the result of atherosclerotic degeneration, fibromuscular dysplasia, or traumatic injury. Because of the risk of aneurysm rupture as well as the neurological sequelae caused by cerebral atheroembolism, surgical intervention is usually required. Internal jugular vein cannulation is the preferred approach for temporary hemodialysis catheter placement. However, the patient with renal failure on hemodialysis who has comorbid condition, the risk of pseudoaneurysm of carotid artery is increased. Here we report a patient on hemodialysis who developed common carotid artery pseudoaneurysm following an attempted internal jugular vein catheterization. A review of relevant literature is also presented.
Aneurysm ; Aneurysm, False* ; Carotid Arteries ; Carotid Artery, Common* ; Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Embolism, Cholesterol ; Fibromuscular Dysplasia ; Humans ; Jugular Veins ; Renal Dialysis* ; Renal Insufficiency ; Rupture

Severe hyperemesis gravidarum (HG) is a rare but potentially devastating complication of pregnancy. It can cause dehydration, electrolyte imbalance, malnutrition (especially, thiamine deficiency), and compromised renal function. We report a case of acute renal failure (ARF) with Wernicke's encephalopathy and beriberi due to severe HG. A 35-year-old woman at 16 weeks of gestation presented with confused mentality, quadriparesis, nystagmus, peripheral neuropathy, and tachycardia after prolonged nausea and vomiting. Her initial serum creatinine and blood urea were 2.6 mg/dL and 100 mg/dL, respectively. FLAIR image of the initial MR examination demonstrated bilateral symmetric high signal intensities in the medial and dorsal thalami. Echocardiography showed left ventricular dilatation and dysfunction. We thought that ARF, Wernicke's encephalopathy and beriberi were resulted from dehydration and thiamine deficiency due to HG. She was managed with intravenous fluid and 100-200 mg of parenteral thiamine. ARF was improved within one week and echocardiographic findings were normalized within 1 month. MR examination at the 21st week of pregnancy showed a decreased size of the lesion. After 4 months, her neuroloic status was recovered.
Acute Kidney Injury* ; Adult ; Beriberi* ; Creatinine ; Dehydration ; Dilatation ; Echocardiography ; Female ; Humans ; Hyperemesis Gravidarum* ; Malnutrition ; Nausea ; Peripheral Nervous System Diseases ; Pregnancy ; Quadriplegia ; Tachycardia ; Thiamine ; Thiamine Deficiency ; Urea ; Vomiting ; Wernicke Encephalopathy*

Idiopathic retroperitoneal fibrosis (IRF) is a rare disease characterized by inflammatory and fibrous tissue proliferation in the retroperitoneum, which often surrounds the adjacent retroperitoneal structure to cause compressive complications such as hydronephrosis. Its pathogenesis is still unknown, but recently the association with autoimmune disease is being suggested. Although the prognosis is generally good, if diagnosis or treatment is delayed, the disease can progress to acute or chronic renal failure. In the past, surgical procedures such as ureterolysis or transpositioning of the involved ureter were the mainstay of the treatment. But recent studies using steroids, immunosuppressants and tamoxifen have reported generally good results. However, the adequate dose or duration of medical treatment and the treatment for recurred disease have not been established yet. We report a case of that retroperitoneal fibrosis recurred 1 year after 2-weeks steroids therapy. It was successfully treated with combination therapy of steroids and tamoxifen.
Autoimmune Diseases ; Diagnosis ; Hydronephrosis ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Prognosis ; Rare Diseases ; Recurrence ; Retroperitoneal Fibrosis* ; Steroids* ; Tamoxifen* ; Ureter

We report a case of focal segmental glomerulosclerosis (FSGS) with chronic renal failure in a patient with unilateral renal artery stenosis. A 38-year-old woman presented with malignant hypertension, massive proteinuria and renal insufficiency. MR angiography showed proximal stenosis of the right renal artery and biopsy of the left kidney revealed focal segmental glomerulosclerosis. The patient responded favorably to the angiotensin II receptor antagonist, as the blood pressure and urinary protein decreased. This case showed that FSGS is a pathophysiologic mechanism of renal injury in uncontrolled renovascular hypertension.
Adult ; Angiography ; Biopsy ; Blood Pressure ; Constriction, Pathologic ; Female ; Glomerulosclerosis, Focal Segmental* ; Humans ; Hypertension, Malignant ; Hypertension, Renovascular ; Kidney ; Kidney Failure, Chronic ; Proteinuria ; Receptors, Angiotensin ; Renal Artery Obstruction* ; Renal Artery* ; Renal Insufficiency ; Renal Insufficiency, Chronic*

The cause of IgA nephropathy is unknown, but a mesangial deposition of IgA immune complexes containing antigens from a putative pathogen might be involved in its pathogenesis. We report a case of IgA nephropathy associated with disseminated tuberculosis. A 32-year-old man was presented with sudden onset of edema of both lower legs. The chest X-ray revealed extensive active pulmonary tuberculosis in both lung fields. The abdominal CT, cystoscopy and IVP were compatible with renal tuberculosis and tuberculous cystitis. Besides, the colonoscopic findings with biopsy showed tuberculous colitis. The laboratory data revealed a positive culture for tuberculous bacilli from sputum, 2.7 g of 24-hour urinary protein, and microscopic hematuria. A renal biopsy showed mesangial and segmental endocapillary proliferative glomerulonephritis, consistent with IgA nephropathy. Intense positive stainings for IgA and C3 in the mesangium by Immunofluorescence microscopy. Electron microscopic examination demonstrates segmental endocapillary proliferation, necrosis and mesangiolysis with mild mesangial electron-dense deposits. Treatment with anti-tuberculous medications resulted in gradual disappearance of proteinuria and other various manifestations of the disseminated tuberculosis. Therefore we suggest that IgA nephropathy may be associated with active disseminated tuberculosis.
Adult ; Antigen-Antibody Complex ; Biopsy ; Colitis ; Cystitis ; Cystoscopy ; Edema ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Leg ; Lung ; Microscopy, Fluorescence ; Necrosis ; Proteinuria ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Tuberculosis, Renal

Peritonitis by Trichoderma longibrachiatum in patients undergoing CAPD has been reported rarely in the literature. We describe a case of peritonitis and intra-abodominal abscess caused by an unusual fungus, Trichoderma longibrachiatum, in a patient undergoing CAPD. The patient was successfully treated with catheter removal, anti-fungal agents and appropriate drainage.
Abdominal Abscess* ; Abscess ; Catheters ; Drainage ; Fungi ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Trichoderma*

Nasogastric (NG) intubation is frequently performed in critically ill patients. Although this procedure is associated with considerable complications, physicians tend to neglect its potential complications. There is also rare case of the reports of perforation of the stomach by an NG tube in adults. We report here on a case of gastric perforation that was caused by an NG tube in a peritoneal dialysis patient who required NG tube insertion for enteral feeding, with a review of the relevant literature.
Adult ; Critical Illness ; Enteral Nutrition ; Humans ; Intubation ; Intubation, Gastrointestinal* ; Peptic Ulcer Perforation ; Peritoneal Dialysis* ; Stomach