RESUMO
CASE PRESENTATION: A 35-year-old man was admitted for recurrent episodes of pneumonia. He complained of a 2-month history of exertional dyspnea and productive cough with whitish and viscous sputum which was poorly responsive to antibiotic therapy. He also reported a weight loss of 5 kg since the first symptoms appeared. There was no dysphagia, fever, or chest pain. He currently did not use medication and did not have a relevant medical history except a current 10 pack-year smoking history. He did not report any history of trauma or respiratory exposure to fats.
Assuntos
Quilotórax , Dieta com Restrição de Gorduras/métodos , Pneumopatias/congênito , Pulmão , Linfangiectasia/congênito , Vasos Linfáticos , Pneumonia , Adulto , Biópsia/métodos , Quilotórax/diagnóstico , Quilotórax/etiologia , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/diagnóstico , Pneumopatias/dietoterapia , Pneumopatias/fisiopatologia , Linfangiectasia/diagnóstico , Linfangiectasia/dietoterapia , Linfangiectasia/fisiopatologia , Vasos Linfáticos/anormalidades , Vasos Linfáticos/diagnóstico por imagem , Linfografia/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pneumonia/diagnóstico , Pneumonia/etiologia , Recidiva , Testes de Função Respiratória/métodos , Escarro , Tomografia Computadorizada por Raios X/métodosAssuntos
Expiração , Pneumopatias/diagnóstico , Linfangiectasia/diagnóstico , Adulto , Broncoscopia , Tosse/etiologia , Dieta com Restrição de Gorduras , Humanos , Pneumopatias/congênito , Pneumopatias/diagnóstico por imagem , Pneumopatias/dietoterapia , Pneumopatias/patologia , Linfangiectasia/congênito , Linfangiectasia/diagnóstico por imagem , Linfangiectasia/dietoterapia , Linfangiectasia/patologia , Masculino , Sons Respiratórios/etiologia , Escarro , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The diagnosis and the clinical course of a 17-year-old white male with chyluria are reported. Cloudy, milky urine appeared spontaneously, in the absence of edema or any signs or symptoms of parasitic infection. Pedal lymphangiography demonstrated the presence of a lymphatic renal fistula, and digital subtraction angiography showed aneurysmal dilatation of the aorta at the level of the renal arteries. This case provided an opportunity to ascertain which of the forms of apolipoprotein B were present in lymph chylomicrons. Apolipoprotein B is needed for chylomicron secretion. It exists in several forms--B-100, B-74, B-48, and B-26. After a meal consisting of fat, chylomicrons in which apolipoprotein B-48 was virtually the only apolipoprotein B present appeared in the urine, while apolipoprotein B-100 was the only apolipoprotein B present in the plasma very low-density lipoproteins. Chyluria disappeared two weeks after institution of a low-fat diet. This case illustrates an interesting, rare cause of chyluria. Because of the presence of chyluria, it was also demonstrated that chylomicrons in which apolipoprotein B-48 is virtually the only apolipoprotein B present are a physiologically normal product of the intestine.
