Kanpo-Masterです
Pathological Evidence of Rhabdomyolysis-induced Acute Tubulointerstitial Nephritis Accompanying Legionella pneumophila Pneumonia
http://jcp.bmj.com/cgi/content/abstract/jcp.2008.057000v1
というお題でJournal of clinical pathologyという英国の雑誌にレジオネラ肺炎によるATIN、横紋筋融解症によるミオグロビンが遠位尿細管につまっている貴重なpathologyの報告をしむらっちょet alでしました。この症例はしむらっちょ＆Kanpo-Masterで相当苦労して救命した一例であり、多くのことを勉強させて頂いた症例でもありました。これもまた世界のどこかで読んでくれる人が沢山いると思います。しむらっちょcongratulation!! wawa先生、英語チェックお疲れ様でした！
We experienced a patient of Legionella pneumophila pneumonia with rhabdomyolysis-induced acute tubulointerstitial nephritis (ATIN) and prolonged renal dysfunction. The case was a 54-year-old man, admitted to our hospital for high-grade fever, ataxia and muscle dysfunction and his chest roentgenogram showed multilobular infiltrations. As L. pneumoniae was detected in his sputum and urine, either by the PCR as well as by culture,he was diagnosed as L. pneumophila pneumonia. Despite the anitmicrobial therapy to Legionella, he further developed renal failure and rhabdomyolysis. The renal biopsy revealed ATIN, by showing the presence of myoglobin casts that occluded the distal tubuli and tubulointerstitial nephritis, leading to the diagnosis of rhabdomyolysis-induced ATIN. Later, the renal function was improved into the normal range, after he discharged on foot. To our knowledge, this is the first pathological evidence that confirmed the involvement of rhabdomyolysis in legionellosis-associated ATIN.
