RESUMO
Bone deformities and fractures are common consequences of renal osteodystrophy in the dialysis population. Persistent hypophosphatemia may be observed with more frequent home hemodialysis regimens, but the specific effects on the skeleton are unknown. We present a patient with end-stage renal disease treated with frequent home hemodialysis who developed severe bone pain and multiple fractures, including a hip fracture and a tibia-fibula fracture complicated by nonunion, rendering her nonambulatory and wheelchair bound for more than a year. A bone biopsy revealed severe osteomalacia, likely secondary to chronic hypophosphatemia and hypocalcemia. Treatment changes included the addition of phosphate to the dialysate, a higher dialysate calcium concentration, and increased calcitriol dose. Several months later, the patient no longer required a wheelchair and was able to ambulate without pain. Repeat bone biopsy revealed marked improvements in bone mineralization and turnover parameters. Also, with increased dialysate phosphate and calcium concentrations, as well as increased calcitriol, circulating fibroblast growth factor 23 levels increased.
Assuntos
Fraturas Ósseas , Hemodiálise no Domicílio/efeitos adversos , Hipofosfatemia/diagnóstico , Falência Renal Crônica/terapia , Osteomalacia , Fosfatos , Calcificação Fisiológica/efeitos dos fármacos , Calcificação Fisiológica/fisiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Soluções para Diálise/farmacologia , Gerenciamento Clínico , Feminino , Fator de Crescimento de Fibroblastos 23 , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Hemodiálise no Domicílio/métodos , Humanos , Testes de Função Renal/métodos , Efeitos Adversos de Longa Duração/sangue , Efeitos Adversos de Longa Duração/diagnóstico , Pessoa de Meia-Idade , Osteomalacia/sangue , Osteomalacia/diagnóstico , Osteomalacia/etiologia , Fosfatos/administração & dosagem , Fosfatos/metabolismo , Resultado do TratamentoRESUMO
We describe a patient with cutaneous T-cell lymphoma who developed Corynebacterium jeikeium sepsis after experimental treatment with 8-methoxypsolaren. The epidemiology and clinical features of C. jeikeium infection are discussed. The patient was successfully treated with intravenous vancomycin without recurrence.