Uremic Leontiasis Ossea: Theoretical Concepts and Practical Considerations.

Leontiasis ossea (LO) in chronic kidney disease patients, also known as Sagliker syndrome, is an exceptionally uncommon uremic complication of long-lasting and severe secondary hyperparathyroidism. The prominent features of uremic LO (ULO) encompass the characteristic clinical trial of massive thickening of maxillary and mandibular bones, widening of interdental spaces, and flattening of nasal bridges and nares. Moreover, during the transformation of craniofacial architecture, significant structural and functional consequences may appear, including upper airway patency, visual and hearing acuity, oral phase of swallowing as well as various neurological and psychiatric disorders. Only few cases of ULO have been reported in the literature until now, making challenging not only the traditional diagnostic procedures but also the optimal therapeutic approach. In this narrative review, we aim to explore the underlying pathophysiological mechanisms, summarize the evidence for adverse outcomes, and highlight the current therapeutic strategies for ULO prevention and treatment, given that precise genetic determinants remain elusive.

Rosuvastatin and Colchicine combined myotoxicity: lessons to be learnt.

Statins and colchicine co-administration consists of a potentially catastrophic drug-drug interaction since it provokes myotoxicity, myopathy and various degrees of rhabdomyolysis. Lipophilic statins and colchicine are biotransformed in the liver, primarily via CYP3A4 enzyme system leading to elevated blood levels of both agents and resulting in increased potential for combined myotoxicity. Hence, it would be of great clinical importance not only the awareness of this devastating complication but also the more advantageous type of statin that we should choose to achieve the recommended therapeutic goals regarding LDL levels with minimal myopathy risk. Therefore, once colchicine's use is commenced, a hydrophilic statin selection, such as rosuvastatin, seems favorable regarding the risk of myotoxicity. Herein, we aim to describe a patient with chronic kidney disease stage III and nephrotic syndrome that developed acute rhabdomyolysis soon after the administration of rosuvastatin while receiving colchicine. To the best of our knowledge, this is the first report of the combined effect of rosuvastatin and colchicine in the setting of chronic kidney disease leading to myotoxicity.

Fondaparinux-Associated Rectus Sheath Hematoma: Skating on Thin Ice.

Rectus sheath hematoma (RSH), an exceptionally rare clinical entity, results from the rupture of epigastric arteries or tear of the rectus abdominis muscle itself. Spontaneous RSH represents a potentially life-threatening bleeding complication in anticoagulated patients with distinct characteristics. The non-specific nature of RSH clinical manifestations renders RSH a kaleidoscopic disease that may be misdiagnosed. The widespread use of anticoagulants for deep vein thrombosis (DVT) prophylaxis or therapy is among the most commonly documented risk factors. To the best of our knowledge, this is the first report of a fondaparinux-associated giant RSH in a 58-year-old Caucasian man who presented with severe pain at the right abdominal quadrant accompanied with a large ecchymosis secondary to violent cough due to a respiratory infection. The aim of our study is to broaden current knowledge regarding the predisposing factors, the pathophysiological mechanisms, and the management of this bleeding disorder.