The risk of tuberculosis in renal transplant recipients may be related to immunosuppressive therapy, and it continues to complicate transplantation in the cyclosporine era. Extrapulmonary manifestation and dissemination also common clinical findings in the transplant recipients. Intestinal tuberculosis that develops with the involvement of other organs is common. We present a case of tuberculous intestinal perforation in the living-related donor renal transplant recipient. A 42-year-old male was admitted because of sudden onset acute abdomen. In April 1995, he received allograft kidney from HLA-identical sister following treatment with cyclosporine-A and low-dose steroids. Allograft function was stable over the next 36 months. About 3 years later, multiple cervical lymph node swelling was observed. Initial lymph node biopsy was performed, which showed granulomatous lesions with positive AFB stain. The patient was treated with antituberculous therapy regimen included isoniazid, ethambutol and rifampicin for a month. A ultrasonography and CT of the abdomen showed multiple adhesions in the peritoneum and enlargement of the mesenteric lymph nodes. A laparatomy finding was inflammatory thickening of the bowel wall in the terminal ileum with necrotic perforation. The involved terminal ileum was removed together with end-to-end anastomosis and peritoneal lavage was done. The patient was improved two weeks after surgical laparotomy.
Abdomen ; Abdomen, Acute ; Adult ; Allografts ; Biopsy ; Cyclosporine ; Ethambutol ; Humans ; Ileum ; Intestinal Perforation* ; Isoniazid ; Kidney ; Kidney Transplantation* ; Laparotomy ; Lymph Nodes ; Male ; Peritoneal Lavage ; Peritoneum ; Rifampin ; Siblings ; Steroids ; Tissue Donors ; Transplantation ; Tuberculosis ; Tuberculosis, Lymph Node ; Ultrasonography

A 68-year-old woman visited our emergency center because of hematemesis. An emergency endoscopy showed an exposed vessel with blood flowing into the upper esophagus. Angiography revealed the presence of extravasation of contrast at the level of the aortic arch and a tortuous fistula between the aortic arch and esophagus. Chest computerized tomography demonstrated the presence of an aortoesophageal fistula and air bubbles inside the fistula. The patient had emergency surgery and the intraoperative findings revealed an aortoesophageal fistula and necrotic materials with a foul odor at the upper esophagus. Primary closure and wrapping of the aorta were performed, but primary closure of the esophagus was impossible because of necrosis. An aortoesophageal fistula is a rare but life-threatening disease. As shown for this patient, an exposed vessel without ulceration at the upper esophagus should raise suspicion of an aortoesophageal fistula and a CT scan or angiography should be performed before endoscopic intervention.
Aged ; Angiography ; Aorta ; Aorta, Thoracic ; Emergencies ; Endoscopy ; Esophagus ; Female ; Fistula* ; Hematemesis ; Humans ; Necrosis ; Odors ; Thorax ; Tomography, X-Ray Computed ; Ulcer

Herpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. Odynophagia and dysphagia are major symptoms and the prognosis of immunocompromised patients is variable. We present the case of a cadeveric donor renal transplantation recipient who developed herpes simplex esophagitis shortly after anti-rejection therapy. A 43-years-old female had cadaveric renal transplantation and following treatment with cyclosporine, prednisolone, mycophenolate mofetile. Twelve months later, renal insufficieny and proteinuria were developed. Allograft kidney biopsy showed some evidence of acute rejection. She was treated with 3 successive days of intravenous methylpredinisolone (500 mg/d) therapy and continued tapering of steroids. Two weeks later, she had oral cavity ulceration, odynophagia, dysphagia, epigastric pain, and nausea. Esophagoscopy reveals multiple confluent ulceration in the whole part of esophagus and biopsies showed the epithelial cell were enlarged with prominent nuclei. Immunohistochemically, the epithelial cell were positive with a monoclonal antibody to herpes simplex virus type 1. Treatment was started on intravenous ayclovir and changed to oral agent for 10 days. After treatment, her symptoms and repeat endoscopic findings were improved.
Allografts ; Biopsy ; Cadaver* ; Cyclosporine ; Deglutition Disorders ; Epithelial Cells ; Esophagitis* ; Esophagoscopy ; Esophagus ; Female ; Herpes Simplex* ; Herpesvirus 1, Human ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney ; Kidney Transplantation* ; Mouth ; Nausea ; Prednisolone ; Prognosis ; Proteinuria ; Steroids ; Tissue Donors ; Ulcer

Eosinophilic cholecystitis is a rare disease characterized by transmural leukocyte infiltration composed of more than 90% eosinophils. Eosinophilic cholecystitis is clinically indistinguishable from ordinary cholecystitis, and as a rule it leads to cholecystectomy. We report a case of idiopathic eosinophilic cholecystitis treated with steroids. A 75-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 41.8%. There was no evidence of allergy or parasitic infestation. An abdominal ultrasonography and computed tomography (CT) scan showed an edematous, thickened gallbladder wall, but no gallstones. There was no evidence of eosinophilic infiltration in other organs. Cholecystectomy was not performed because the patient refused surgical management. However, fever, abdominal pain, and peripheral eosinophilia persisted despite antibiotic and conservative therapy. Therefore, we attempted treatment with prednisolone. A week later, the symptoms disappeared and the peripheral eosinophilia normalized.
Abdominal Pain ; Aged ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Eosinophilia ; Eosinophils ; Female ; Fever ; Gallbladder ; Gallstones ; Humans ; Hypersensitivity ; Leukocytes ; Prednisolone ; Rare Diseases ; Steroids

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

Kidney Transplantation* ; Respiratory Distress Syndrome, Adult ; Tuberculosis, Miliary*

PURPOSE: The medical records of 524 renal recipients who have been transplanted until December 2000 in our hospital were reviewed in order to compare the incidence of the surgical and medical complications according to their different treatment protocols. METHODS: To compare the surgical complications, the recipients were divided according to their ureter reconstruction method and donor type. Group 1; living donor and modified Politano method are done. Group 2; living donor but an extravesical ureteroneocystostomy. Group 3; cadaver donor and an extravesical anastomosis. Regarding the medical complications, recipients who received Sandimmun based immunosuppression (with steroid and/or azathioprine) were grouped as 1, those recipients with Neoral based immunosuppression (with steroid and/or cellcept) were grouped as 2, and re-cipients immunosuppressed by prograf based immunosuppression (with steroid and/or cellcept) were grouped as 3. The incidence of complications and adverse effects in each group and per recipient were described as the percentage of the total incidence. RESULTS: Most of the surgical complications including an allograft rupture, ureteral fistula, lymphocele and reoperation due to bleeding were developed during the first month after transplantation but decreasing in group 2 and 3. An ureter stricture and renal artery stenosis developed after 6 months. Infectious complications were developed in 60.7% of recipients and among them, a viral infection occurred in 41.9% which was followed by bacterial and fungal infection. However, the incidence of infection also decreased in group 3. Herpes infections were the most common in viral infection and their incidence showed a dual peak (within 6 months and after 1 year). The recurrence of the original disease, mostly a focal sclerosing glomerulosclerosis, and de novo cancer showed lower incidence in group 3 but the follow up duration should be considered. Tremor and hirsutism are two of the most common adverse effects but showed a different incidence in group 3. Some side effects such as diarrhea, post-transplant diabetes were more common in group 3 than in group 1 and 2. CONCLUSION: The decreasing incidence of complications and the drug side effects in recent days might be due to a better understand of the surgical procedures and the development of new immunosuppressants. However, new side effects or toxicity by new immunosuppressant must be considered seriously.
Allografts ; Cadaver ; Clinical Protocols ; Constriction, Pathologic ; Cyclosporine ; Diarrhea ; Fistula ; Follow-Up Studies ; Hemorrhage ; Hirsutism ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation* ; Living Donors ; Lymphocele ; Medical Records ; Recurrence ; Renal Artery Obstruction ; Reoperation ; Rupture ; Tacrolimus ; Tissue Donors ; Tremor ; Ureter

Cytomegalovirus (CMV) remains an important pathogen in organ transplant patients. However, cutaneous lesions are rare manifestation of systemic CMV infection. We report a case of CMV panniculitis in a 47-year-old renal transplant recipient. She admitted due to fever, local pain in the left pelvic area, and erythematous tender palpable mass for 2 weeks. Twenty years ago, she underwent renal transplantation and had taken azathioprin 100 mg and prednisone 10 mg daily. Serum creatinine had been preserved between 2.5 and 3.5 mg/dL. Bacterial, fungal, and AFB cultures of skin lesion and drained pus were negative. CMV antigenemia was noted. Skin biopsy revealed multinucleated dermal histiocytes and positive for CMV antibody by immunohistochemical staining. Polymerase chain reaction testing of skin tissue and drained pus revealed CMV DNA. She was treated with ganciclovir for four weeks and skin lesion was completely resolved without recurrence.
Biopsy ; Creatinine ; Cytomegalovirus* ; DNA ; Fever ; Ganciclovir ; Histiocytes ; Humans ; Kidney Transplantation* ; Middle Aged ; Panniculitis* ; Polymerase Chain Reaction ; Prednisone ; Recurrence ; Skin ; Suppuration ; Transplantation ; Transplants

Rendu-Osler-Weber disease is characterized by hereditary transmission, and by the presence of multiple telangiectases of the skin, mucous membranes, and internal organs. We present a case of Rendu-Osler-Weber disease with bleeding from gastric telangiectases that was successfully treated by endoscopy with the use of argon plasma coagulation (APC). A 65-year-old woman presented with melena. Endoscopy disclosed multiple telangiecatses in the whole stomach. APC was performed at an output of 50 W and with an argon gas flow rate of 2 L/min. Only multiple ulcers at the treated sites were seen 7 days after the procedure and fibrotic scars with contracted mucosal folds without active bleeding signs were noted 2 months later.
Aged ; Argon ; Argon Plasma Coagulation ; Cicatrix ; Contracts ; Endoscopy ; Female ; Hemorrhage ; Humans ; Melena ; Mucous Membrane ; Skin ; Stomach ; Telangiectasia, Hereditary Hemorrhagic ; Telangiectasis ; Ulcer

BACKGROUND/AIMS: Left colonic diverticulitis is relatively common in western nations. Although the incidence of colonic diverticulitis is increasing in Korea, very little is known regarding its clinical characteristics in korean patients. METHODS: We compared the clinical characteristics of right versus left colonic diverticulitis via the retrospective review of 37 cases treated at the Kyungpook National University Hospital, Korea, from July 1998 to December 2006. Diagnosis was confirmed via computed tomography (CT), barium study, colonoscopy, and/or surgery. RESULTS: Eighteen men and 19 women (median age, 45.0 years; range, 21~75 years) were included. The ratio of right to left colonic diverticulitis was 30:7. The male to female ratio for right colonic diverticulitis was 16:14 and the median age was 38.5 years (range, 21~72 years). The male to female ratio for left colonic diverticulitis was 2:5 and the mean age was 57.0 years (range, 45~75 years). Left colonic diverticulitis was more frequently associated with intestinal perforation (p=0.001) and old age (p=0.005). Surgical intervention was more common in left versus right colonic diverticulitis (p=0.009). CONCLUSIONS: These results indicate that although left colonic diverticulitis is relatively rare among koreans, it develops later in life and is more frequently complicated than right colonic diverticulitis.
Barium ; Colon ; Colonoscopy ; Diverticulitis, Colonic ; Female ; Humans ; Incidence ; Intestinal Perforation ; Korea ; Male ; Retrospective Studies