Vancomycin-induced agranulocytosis is a rare side effect, but the increased use of vancomycin may disclose a more frequent occurrence. And it is a life-threatening complication, especially in end stage renal disease (ESRD) patients. We describe a 62-year-old patient with continuous ambulatory peritoneal dialysis (CAPD), who developed agranulocytosis after 3 weeks intraperitoneal administration of vancomycin for treatment of peritonitis caused by methicillin-resistant Staphylococcus haemolyticus. The agranulocytosis was resolved with granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin. But, the patient developed subsequent rhinocerebral mucormycosis with invasion to skull base associated prolonged neutropenic period and expired in spite of surgical resection and intravenous administration of amphotericin. This case serves as a reminder to clinicians that patients receiving long-term treatment with vancomycin should have their white blood cell count monitored and vancomycin-induced agranulocytosis should be corrected promptly.
Administration, Intravenous ; Agranulocytosis* ; Amphotericin B ; Granulocyte Colony-Stimulating Factor ; Humans ; Kidney Failure, Chronic ; Leukocyte Count ; Methicillin Resistance ; Middle Aged ; Mucormycosis* ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis* ; Skull Base ; Staphylococcus haemolyticus ; Vancomycin

Kidney transplantation is a ideal renal replacement therapy in the patient with end stage renal disease. It made improvement of the patients' life quality but made increase of the incidence of chances of malignant diseases of them. We report a 44-year-old male kidney recipient recently diagnosed as early gastric cancer, had diagnosed previously as malignant lymphoma 6 years ago. He received a kidney from his mother 13 years ago, and then 7 years later he was diagnosed as malignant lymphoma presented as 2.5 cm-sized solitary lung mass. Histologically, it was confirmed as diffuse large cell type lymphoma. After 2-year scheduled chemotherapy and radiation therapy, he achieved complete remission. He was diagnosed as early gastric cancer by routine Upper Gastro-Intestinal Series study. Histologically, it was defined as moderately differentiated adenocarcinoma. He underwent a subtotal gastrectomy (Billoth-II). After the operation, he preserved good graft function with no recurrence of malignancy until now. Briefing our case, a kidney recipient has been serially diagnosed different two kinds of malignancy, malignant lymphoma and early gastric cancer with interval of 7 years. He showed good responses to therapy of malignancies and excellent prognosis. We recommend specific schedule of regular malignancy screening test for kidney recipients with long duration of post-transplantation.
Adenocarcinoma ; Adult ; Appointments and Schedules ; Drug Therapy ; Gastrectomy ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Lung ; Lymphoma ; Male ; Mass Screening ; Mothers ; Prognosis ; Quality of Life ; Recurrence ; Renal Replacement Therapy ; Stomach Neoplasms ; Transplants

Vascular access is the prerequisite and mainstay of extra-corporeal renal replacement therapy and its management is central to maintain the health and quality of life of end-stage renal disease (ESRD) patients. Success of maturation of AVF depends on the quality and size of the vessels and anatomic structure. There have been several reports on non-maturation by vascular stenosis or small vascular size after AVF procedure, but reports demonstrating that AVF non-maturation is due to by latent vessel variation are uncommon. We report a rare case of scalp edema and insufficient maturation of AVF due to cephalic vein variation in a 27 year-old female patient with ESRD on hemodialysis. Conclusively, meticulous observation on not only vessels used for AVF but also its proximal connection to other vessels should be considered.
Adult ; Arteriovenous Fistula* ; Constriction, Pathologic ; Edema* ; Female ; Humans ; Kidney Failure, Chronic* ; Quality of Life ; Renal Dialysis ; Renal Replacement Therapy ; Scalp* ; Veins*

The most frequent cause of continuous ambulatory peritoneal dialysis (CAPD) drainage failure is catheter migration. We experienced a rare case of CAPD drainage failure due to fracture of Tenckhoff catheter. A 56-year-old man presented for evaluation of CAPD drainage failure. KUB showed broken radio opaque line of the Tenckhoff catheter proximal to the internal cuff. It was thought that CAPD drainage failure was due to catheter fracture. CAPD drainage failure had been treated successfully with surgical catheter reinsertion. Our case demonstrated that catheter fracture should be considered in the differential of CAPD drainage failure.
Catheters* ; Drainage* ; Humans ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory*

In patients on peritoneal dialysis, ultrafiltration can be decreased after long-term dialysis. To solve this problem, icodextrin has been developed and used instead of glucose. Icodextrin infused into the peritoneal cavity is partially absorbed via lymphatics into the systemic circulation and hydrolyzed, and then its metabolites lead to measurement of high capillary blood glucose levels by reacting with the test strip. This excessive measurement of capillary blood glucose levels can lead to unawareness of hypoglycemia, but there has been no report of such cases in our country. A 26-year-old female patient who was on peritoneal dialysis with 7.5% icodextrin (Extraneal: Baxter Corporation, Chicago, IL, USA) presented with convulsion and hypoglycemia. To alert our physicians, we report it with a review of the literature, and recommend when a patient on peritoneal dialysis with icodextrin, blood sugar levels should be cross checked by other laboratory reference methods.
Adult ; Blood Glucose* ; Capillaries* ; Dialysis ; Female ; Glucose ; Humans ; Hypoglycemia ; Peritoneal Cavity ; Peritoneal Dialysis* ; Seizures* ; Ultrafiltration

There are a few reports about coexistence of Henoch-Schonlein purpura (HSP) and a variety of malignancy in adults. The accompanying malignancies, in order of frequency, were hematologic malignancy, lung cancer and prostate cancer. Gastrointestinal tract (GIT) cancer associated with HSP was rarely reported which includes 2 cases of stomach cancer, 1 case of small bowel cancer and 1 case of esophageal cancer. Malignancy is proposed to be a triggering factor in the development of HSP, however pathogenesis of HSP associated with malignancy remains obscure. Here, we report 2 cases of HSP associated with malignancy in GIT. One is an adenocarcinoma of the colon and the other is a stomach adenocarcinoma with signet ring cell component.
Adenocarcinoma* ; Adult ; Cellular Structures ; Colon* ; Esophageal Neoplasms ; Gastrointestinal Tract ; Hematologic Neoplasms ; Humans ; Lung Neoplasms ; Prostatic Neoplasms ; Purpura, Schoenlein-Henoch* ; Stomach Neoplasms ; Stomach*

Diabetic muscle infarction (DMI) is a rare complication of diabetes. Its clinical features are similar with infectious diseases. We report DMI in a 44-yr-old woman with a 18 year history of type 2 diabetes and a 4 year history of end-stage renal disease on hemodialysis. She was admitted for a 2 day history of severe pain and swelling in the right thigh. It developed spontaneously without trauma. Physical examination revealed tenderness on the right thigh and body temperature was normal. Peripheral pulses of right leg were good at the tibialis posterior and dorsalis pedis. There was no deep vein thrombosis in the lower limb on Doppler ultrasound. MRI showed a diffuse swelling and increased signal of quadriceps muscle group in T2 weighted images. She was diagnosed as having DMI and improved following conservative therapy. There was no recurrence during the follow up. DMI could be investigated by clinical findings and MRI imaging in diabetic patients on maintenance hemodialysis.
Body Temperature ; Communicable Diseases ; Female ; Follow-Up Studies ; Humans ; Infarction* ; Kidney Failure, Chronic ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Physical Examination ; Quadriceps Muscle ; Recurrence ; Renal Dialysis* ; Thigh ; Ultrasonography ; Venous Thrombosis

Sjogren's syndrome is an autoimmune disease causing eye or dry mouth from the lymphocytic infiltration in the lacrimal gland and the salivary gland, and is classified as primary or secondary based on the absence or presence of complicating systemic rheumatic diseases. Extraglandular systemic lesions involving organs such as the lungs, liver, and kidney are seen, and renal involvement of these is reported to occur in 20% to 50% of patients with primary Sjogren's syndrome, and most commonly manifested with a tubulointerstitial nephritis. But a little over 20 cases with glomerulonephritis have been reported in the literature review, and only one case was reported in Korea. Glomerulonephritis is a late sequelae in the course of the disease, and is most attributed to deposition of immune complexes. Membranoproliferative glomerulonephritis are the most common glomerular lesions and only one case of minimal change nephrotic syndrome was reported in the literature review, and no previous case was reported in Korea. We report a minimal change nephrotic syndrome that is concurrently manifested with sicca complex in a case of Sjogren's syndrome.
Antigen-Antibody Complex ; Autoimmune Diseases ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Humans ; Kidney ; Korea ; Lacrimal Apparatus ; Liver ; Lung ; Mouth ; Nephritis, Interstitial ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Rheumatic Diseases ; Salivary Glands ; Sjogren's Syndrome*

Thrombosis is one of the important complications of nephrotic syndrome. The mechanism of vascular thrombosis in nephrotic syndrome is under debate, but the hypercoagulable state is regarded as a predisposing factor to that. Most of vascular thrombosis in nephrotic syndrome have occurred in veins. Arterial thrombosis is relatively uncommon and often related with steroid or diuretic use. We experienced a case of bilateral popliteal arterial occlusion due to femoral arterial thrombosis as the first presentation of nephrotic syndrome. A 59-year old male patient was admitted with complaints of pain on left lower extremity for five days. The diagnosis of thrombosis in left popliteal artery was made by arterial angiography. The emergent thrombolytic therapy and anticoagulation was performed. During anticoagulation, another episode of bilateral popliteal arterial occlusion was occurred once again. He had heavy proteinuria, and renal pathology revealed minimal change disease. There was no recurrence of thrombosis for 1 year after treatment with steroid and warfarin.
Angiography ; Causality ; Diagnosis ; Humans ; Lower Extremity ; Male ; Middle Aged ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pathology ; Popliteal Artery ; Proteinuria ; Recurrence ; Thrombolytic Therapy ; Thrombosis* ; Veins ; Warfarin

Hemorrhagic fever with renal syndrome (HFRS) is characterized clinically by the triad with fever, hemorrhage and renal failure. The hemorrhage in HFRS varies from transient petechial skin lesions to fulminant and massive internal bleeding. The latter can be an important cause of death in HFRS. A 52-year-old male was admitted to our hospital presenting with fatigue, fever, diplopia and right ear deafness. Rapid test for detecting Hantaan virus antibody was positive, so we diagnosed his case as HFRS. We also performed prism cover test, pure tone audiogram, tympanometry and temporal magnetic resonance imaging (MRI) for evaulate his diplopia and right ear deafness. Pure tone audiogram revealed right ear deafness and temporal MRI revealed right cochlear hemorrhage. After two weeks management, he recovered from HFRS and diplopia, but not from right ear deafness. We here report a case of hemorrhagic fever with renal syndrome complicated by sudden sensorineural hearing loss caused by cochlear hemorrhage and isolated abducens nerve palsy, which has not been submitted in Korea.
Abducens Nerve Diseases* ; Abducens Nerve* ; Acoustic Impedance Tests ; Cause of Death ; Deafness ; Diplopia ; Ear ; Fatigue ; Fever ; Hantaan virus ; Hearing Loss, Sensorineural ; Hemorrhage* ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Korea ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Renal Insufficiency ; Skin