A Case of Acute Renal Failure with Wernicke's Encephalopathy and Beriberi due to Severe Hyperemesis Gravidarum / 대한신장학회지

Severe hyperemesis gravidarum (HG) is a rare but potentially devastating complication of pregnancy. It can cause dehydration, electrolyte imbalance, malnutrition (especially, thiamine deficiency), and compromised renal function. We report a case of acute renal failure (ARF) with Wernicke's encephalopathy and beriberi due to severe HG. A 35-year-old woman at 16 weeks of gestation presented with confused mentality, quadriparesis, nystagmus, peripheral neuropathy, and tachycardia after prolonged nausea and vomiting. Her initial serum creatinine and blood urea were 2.6 mg/dL and 100 mg/dL, respectively. FLAIR image of the initial MR examination demonstrated bilateral symmetric high signal intensities in the medial and dorsal thalami. Echocardiography showed left ventricular dilatation and dysfunction. We thought that ARF, Wernicke's encephalopathy and beriberi were resulted from dehydration and thiamine deficiency due to HG. She was managed with intravenous fluid and 100-200 mg of parenteral thiamine. ARF was improved within one week and echocardiographic findings were normalized within 1 month. MR examination at the 21st week of pregnancy showed a decreased size of the lesion. After 4 months, her neuroloic status was recovered.

A Case of Juxtaglomerular Cell Tumor / 대한신장학회잡지

The juxtaglomerular cell tumor is a rare benign tumor which causes surgically correctable hypertension. We report a case of hypertension caused by juxtaglomerular cell tumor in a 17-year old man. He presented with hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism. Renal angiography showed no evidence of renal artery stenosis. Though no mass was suspected in renal angiography, CT scan showed a well demarcated mass, 3 cm in diameter, in the upper portion of left kidney, which was resected and diagnosed to be a juxtaglomerular cell tumor. After resection of the tumor, blood pressure was normalized with resolution of hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism.

A Case of Septicemia and Septic Pneumonia due to Burkholderia pseudomallei / 감염과화학요법

Melioidosis is an infectious disease caused by a gram-negative saprophyte bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It mostly infects adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ. The spectrum of melioidois in human varies from subclinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. We report herein a case of septicemia and septic pneumonia due to Burkholderia pseudomallei in 47-year-old man with diabetes mellitus who has history of traveling to Malaysia. This is the first report of melioidosis in Korea.

A Case of Septicemia and Septic Pneumonia due to Burkholderia pseudomallei / 감염과화학요법

Melioidosis is an infectious disease caused by a gram-negative saprophyte bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It mostly infects adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ. The spectrum of melioidois in human varies from subclinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. We report herein a case of septicemia and septic pneumonia due to Burkholderia pseudomallei in 47-year-old man with diabetes mellitus who has history of traveling to Malaysia. This is the first report of melioidosis in Korea.

A case of calcium pyrophosphate dihydrate deposition disease causing compressive cervical myelopathy / 대한내과학회지

Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structure. Spinal involvement in CPPD deposition disease is rare. We reported a rare case of CPPD deposition disease that caused compressive cervical myelopathy. A 57-year-old woman was admitted to the hospital with 1 week history of progressive paresis of the right upper and lower extremities. Computed tomography showed the round and nodular calcified ligamentum flavum. Magnetic resonance imaging showed a low intensity epidural mass pressing and distorting the cervical cord at C-4 and 5 levels on both T1 and T2- weighted images. Radiographic findings were consistent with calcification of the ligamentum flavum in the C-4 and 5 levels causing cord compression. The lesion was eventually removed by hemilaminectomy. The mass was composed of a very hard crystal like calcified deposition in the ligamentum flavum. The histopathological evaluation of the exicised ligamentum flavum revealed the characteristic crystals of CPPD.

A Case of Systemic Capillary Leak Syndrome Following Upper Respiratory Tract Infection / 대한신장학회잡지

Systemic capillary leak syndrome is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with paraproteinaemia. We experienced a case of recurrent systemic capillary leak syndrome. A 30-year-old woman had flu-like syndrome with fever, chill, and sore throat. Two days later, she presented progressive generalized edema and weight gain of 4 kg. Biological examination showed hemoconcentration, leukocytosis, and hypoalbuminemia without proteinuria. A radiograph of the chest showed pleural effusion. She had no evidence of heart failure, renal failure, or a protein losing enteropathy, and no abnormalities of liver function. Anti-neuclear antibody and antibodies to ds-DNA were negative. C3 and C4 were decreased. Serum protein electrophoresis showed oligoclonal banding consisting of IgG bands. Bone marrow biopsy was normal and there was no Bence-Jones protein in urine. She experienced a progressive reduction in her weight and a resolution of the peripheral edema without specific treatment. Five months later, she was readmitted with severe episode of shock. After a total of 10 L of fluid was administered intravenously, pulmonary edema developed. Intravenous steroid and theophylline were given which resulted in clinical improvement, accompanied by diuresis. Oral theophylline has been administered for prevention of this crisis up to the present time.