Acute Kidney Injury due to Rbadomyolysis Complicated with Zolpidem Overdose / 대한내과학회지

Zolpidem (Stilnox®, Handok, Seoul, Korea) is a hypnotic imidazopyridine that is often used to treat insomnia because it has less abuse and addiction potential than benzodiazepines. Its side effects include headache, dizziness, and nausea, but these are mild. Zolpidem intoxication rarely has severe complications. Here, we report a case of acute kidney injury due to rhabdomyolysis related to zolpidem. A 51-year-old man was admitted with drowsy mentality after taking an overdose of zolpidem in a suicide attempt. Laboratory findings showed a blood urea nitrogen of 59.9 mg/dL, serum creatinine of 5.8 mg/dL, and creatine phosphokinase of 16,210 IU/L. Acute kidney injury associated with rhabdomyolysis complicating zolpidem intoxication was diagnosed. The patient was managed with hemodialysis and recovered completely in terms of renal function and muscle enzyme levels.

A Case of a Calcitonin-Secreting Pancreatic Endocrine Tumor in a Pateint with Multiple Endocrine Neoplasia Type 1 / 대한내과학회지

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant hereditary disorder characterized by the combined occurrence of tumors of the parathyroid gland, exocrine pancreas, and anterior pituitary gland. Calcitonin-secreting pancreatic endocrine tumors are rare, and calcitonin-secreting pancreatic endocrine tumors with MEN1 have not been reported in Korea. A 46-year-old woman was admitted for a right breast cancer operation. Abnormal blood chemistry findings were hypercalcemia and elevated calcitonin. The patient was diagnosed with a calcitonin-secreting pancreatic endocrine tumor, left thyroid papillary carcinoma, right breast invasive ductal carcinoma, a thymic carcinoid tumor, left adrenal adenoma, uterine myoma, and adenomyosis by computed tomography scan, and with pituitary macroadenoma by brain magnetic resonance imaging. We present this case with a review of the literature, because it is the first reported calcitonin-secreting pancreatic endocrine tumor with MEN 1 in Korea.

A Case of Primary Aldosteronism Accompanied by Hypokalemic Rhabdomyolysis / 영남의대학술지

Primary aldosteronism is characterized by hypertension, hypokalemia, and metabolic alkalosis, associated with excessive aldosterone production and suppressed plasma renin activity. Hypokalemia-induced rhabdomyolysis has been rarely reported in primary aldosteronism patients. This paper reports a case of primary aldosteronism presented with rhabdomyolysis due to severe hypokalemia. A 48-year-old male with a three-year history of hypertension presented himself at the authors' hospital with generalized weakness and myalgia in both legs over a period of several days. His laboratory findings showed hypokalemia (1.8 mEq/L) with elevations of his serum creatine phosphokinase and serum myoglobin. His plasma aldosterone level was also elevated, and his plasma renin activity was reduced. An abdominal computed tomography revealed a 2.0 cm hypodense mass in the left adrenal gland, which suggested adrenal adenoma. The accordingly underwent laparoscopic adrenalectomy. Three months later, his plasma potassium level and blood pressure became normal without the use of medications.

Candida Arthritis Presenting as a Huge Popliteal Cyst in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature / 대한내과학회지

Candida arthritis is an uncommon cause of infectious arthritis that can occur in immunocompromised patients, such as those with rheumatoid arthritis. Candida arthritis arises in two ways: from direct inoculation or hematogenous dissemination. Direct inoculation is common in immunocompromised hosts during intra-articular injection or surgical procedures. The affected joints are generally swollen, tender, and mildly warm, with no evidence of disseminated candidiasis. Reported treatments include intravenous amphotericin B administration and drainage, or the use of 5-fluocytosine or ketoconazole to decrease amphotericin B toxicity. Surgical treatment has been necessary in some cases to eradicate candidal infection. Here, we report a case of candida arthritis combined with a huge popliteal cyst in a patient with rheumatoid arthritis and present a review of the relevant literature.

Candida Arthritis Presenting as a Huge Popliteal Cyst in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature / 대한내과학회지

Candida arthritis is an uncommon cause of infectious arthritis that can occur in immunocompromised patients, such as those with rheumatoid arthritis. Candida arthritis arises in two ways: from direct inoculation or hematogenous dissemination. Direct inoculation is common in immunocompromised hosts during intra-articular injection or surgical procedures. The affected joints are generally swollen, tender, and mildly warm, with no evidence of disseminated candidiasis. Reported treatments include intravenous amphotericin B administration and drainage, or the use of 5-fluocytosine or ketoconazole to decrease amphotericin B toxicity. Surgical treatment has been necessary in some cases to eradicate candidal infection. Here, we report a case of candida arthritis combined with a huge popliteal cyst in a patient with rheumatoid arthritis and present a review of the relevant literature.

Two Cases of Severe Pancytopenia Associated with Low-Dose Methotrexate Therapy in Patients with Chronic Kidney Disease and Rheumatoid Arthritis / 영남의대학술지

Due to its efficacy and tolerability, low dose oral methotrexate(MTX) therapy has been widely used for treatment of rheumatoid arthritis(RA). However, it can rarely cause serious, life-threatening hematologic toxicities, such as pancytopenia. We report here on two patients with chronic kidney disease(CKD), who developed severe pancytopenia after 5 years (cumulative dose 1,240mg) and 4 years(cumulative dose 1,320mg) of low dose MTX therapy for treatment of RA, respectively. Both patients presented with renal insufficiency, hypoalbuminemia, concurrent use of nonsteroidal anti-inflammatory drugs, and elevated mean corpuscular volume of red blood cells(RBCs), all of which are known as risk factors of MTX-induced pancytopenia. Despite receiving treatment, which included RBC and platelet transfusions, antibiotic therapy, granulocyte colony stimulating factor, and leucovorin rescue, one patient died of sepsis. Based on our case study, prompt investigation of risk factors associated with MTX toxicity is required for all patients receiving MTX therapy. MTX treatment, even at a low dose, should be discontinued in patients with advanced CKD.