1/23. Anterior urethral valve in an adolescent boy. A 14 year old boy with a relatively uncommon anterior urethral valve is described herein. ( info) |
2/23. Pyocystis: two case reports of patients in renal failure. Two cases of pyocystis in patients in end-stage renal disease are reported. Pyocystis is a recognized complication of urinary diversion procedures, but also occurs in anuric or oliguric hemodialysis patients. The treatment differs from ordinary cystitis, requiring catheterization, bladder irrigation, and intravesical antibiotic instillation. When undiagnosed, pyocystis may progress to sepsis and death. ( info) |
3/23. Hemoglobinopathy with prolonged bactermia. A report of two cases. Prolonged escherichia coli bacteremia occurred as a complication of pyelonephritis in two patients with abnormal hemoglobins (SC and SS), despite "appropriate" antibiotic therapy. Careful investigation in each case failed to account for the persistent sepsis. Pyogenic arthritis ultimately developed in both patients. ( info) |
4/23. Persistent flank pain, low-grade fever, and malaise in a woman treated with indinavir. This case report describes a 32-year-old woman treated with indinavir who developed mild to moderate flank pain, malaise, and low-grade fever. Sterile pyuria preceded increased serum creatinine levels. Workup revealed persistent pyuria, normal-sized kidneys, a normal intravenous pyelography, and negative urinary cultures. Renal biopsy showed interstitial nephritis and chronic inflammation. Collecting ducts contained crystals. Two months after treatment with indinavir was discontinued, serum creatinine levels returned to normal and pyuria disappeared. Sterile pyuria in patients taking indinavir may help to identify patients at risk for renal dysfunction and interstitial nephritis. Markedly increasing the fluid intake above the recommended dosage may ameliorate or even reverse the process of tubulointerstitial disease. ( info) |
5/23. Staghorn calculus presenting as sterile pyuria. urinary tract calculi are relatively common and usually symptomatic. We describe a patient who had several very unusual features with regard to his urinary tract calculus disease. ( info) |
6/23. Urinary immunocytology for primary bladder B cell lymphoma. Urinary immunocytology is described as a diagnostic tool in a patient with a primary high-grade, large-cell, B cell lymphoma of the bladder. lymphoma cells were distinguished from abundant leukocytes by immunocytologic staining for CD20. This technique might be useful in the differential diagnosis of patients with chronic bladder inflammation accompanied by pyuria. ( info) |
7/23. dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BACKGROUND: dialysis disequilibrium syndrome (DDS) is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD). We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. CASE PRESENTATION: A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L). diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L) (urea-reduction-ratio 71%). Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. brain death was declared. CONCLUSIONS: Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia. ( info) |
8/23. Prolonged fever and pyuria: an uncommon manifestation of q fever. A patient with q fever is described who had been ill for a year before the diagnosis was made on the basis of serological data. In addition it was possible to isolate coxiella burnetii, the causative agent by culture from the urine. This is very exceptional and is to our knowledge only the second case in which this has been achieved. The patient made a full recovery after lengthy treatment with tetracycline. q fever should be considered in patients with pyrexia of unknown origin, particularly in travellers. ( info) |
| Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction. As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy. ( info) |
10/23. Histological phases of Bactrim-induced fixed drug eruption. The report of one case. A case is described of a patient with Bactrim-induced fixed drug eruption (FDE). Histological studies were performed at 1 day and 5 days after the drug exposure. While the 5-day-old lesion showed changes classically recognized as FDE, the 1-day-old lesion showed changes typical of a hypersensitivity response: diffuse spongiosis, dermal edema and hemorrhage, neutrophilic polymorphonuclear leukocyte abscess formations, and large numbers of eosinophils. This report underscores the dynamic cellular changes that occur in the evolving FDE lesion. ( info) |