Poster Session : PS 0722 ; Rheumatology ; SystemIc Lupus Erythematosus and Castleman Disease Co-Existence in a Patient with Weight Loss and Lymphadenopathy

( Yusuf Hancerli ),( Veysel Ozalper ),( Abdullah Haholu ),( Ramazan Arikan ),( Emrullah Solmazgul ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Objective: Castleman`s disease (CD) is quite rare and its etiology is not clearly unravelled yet. It is a lymphoproliferative disease with giant lymph node hyperplasia. This report presents newly diagnosed SLE and CD association on a 21 year old male who was transferred to our hospital with weight loss, fatigue and multiple lymphadenopathy (LAP) complaints along with the pre-diagnosis of lymphoma. Case Report: In September 2013, the patient was admitted to our Hematology Clinic with the complaints of weakness, neck and arm pit swelling and weight loss. The patient was at 68 kg in November 2012, while admitted to the hospital in September 2013 he was at 47 kg. On physical examination, bilateral cervical, supraclavicular, inguinal and axillary LAP which reached 3-4 cm in size and hepatomegaly was identifi ed. He had pain in both hand`s mid-interfalengeal joints and was unable to move comfortably. Labarotary fi ndings were hemoglobin:10. 5 g/dl, direct coombs +2 positive, platelet 79100 u/l, sedim 96, C-reactive protein 26. 6, ANA: 2. 672 (cut off<0,896), AntidsDNA:2. 517 (cut off<0,947), nRNP/Sm positive, C3: 0. 675 g/dl, C4 :0. 0871 g/ dl,24- hour urine protein 1481. 24 mg. The patient was diagnosed as SLE with the present fi ndings. The excisional biopsy from the right axillary lymph node area which showed the highest activity in PET CT ( SUVmax : 6. 4) was considered signifi cant inthe terms of CD. Conclusion: Altough LAP`s most common causes are malignancy, autoimmune diseases and infections, it would be appropriate to take into consideration lymphoproliferative diseases such as CD in the stage of diagnosis evaluation in spite of very rare occurence.

Poster Session:PS 0195 ; Endocrinology : Acute Renal Failure Due to Vitamin D Intoxication

( Yusuf Hancerli ),( Veysel Ozalper ),( Ibrahim Cetintagli ),( Barbaros Basbug ),( Seyid Ahmet Ay ),( Ramazan Arikan ),( Yalcin Onem ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Objective: Vitamin D defi ciency is associated with multpl diseases.Vitamin D becomes more popular every day with the increasing studies. Vitamin D replacement therapy cases increase as well as Vitamin D intoxication cases. We present a 80-old-female patient who developed acute renal failure due to vitamin D intoxication. Case: Patient came to the emergency room with the complaints of 4-day continuing nausea, vomiting and loss of appetite. Mucosa of the patient was dry and she was dehydrate.Tests results were urea:186mg/dL, creatinine:3.64mg/dl, albumin:3.26 g/dL, calcium:12.7mg/dL and venous blood gas results were pH:7,41,pCO2:41.9 HCO3:26.6. Calcium,urea and creatinine levels were normal in a test that was performed 2 months ago. She was diagnosed with acute pre-renal failure connected to dehydration. A detailed medical history showed that 2.5 months ago, the patient was tested vitamin d3-25-0H (kalsifediyol):6.2 ng/ml and vitamin d3 300 000 IU bulb total of 3 was prescribed to her to be taken orally once a week, however, it was realized that the relatives of the patient gave her total of 10, once a week. After this fi nding, performed test results were detected as vitamin d3-25-0H (kalsifediyol):365 ng/ml, parathyroid hormone:16.8pg/ml. The patient was hospitalized with a diagnosis of vitamin D intoxication and intravenous hydration with saline and IV furosemide infusion therapy was applied. At the end of second day her complaints have decreased and at the end of third day calcium level were 9.3mg/dl. At the tenth day test results were urea:30 mg/ dL,creatinine:1.12 mg/dL, and the patient was discharged. Conclusion: Due to growing interest in vitamin D, it is very important that clinicans should be aware and alerted of that overdose vitamin D replacement therapy can cause vitamin D intoxication.

Poster Session : PS 0601 ; Pulmonology ; Pulmonary Nodules Due to Brucellosis

( Seyit Ahmet Ay ),( Yusuf Hancerli ),( Suna Secil Ozturk Deniz ),( Mustafa Hatipoglu ),( Asım Ulcay ),( Muzaffer Saglam ),( Veysel Ozalper ),( Ferhat Deniz ),( Arif Yonem ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Objective: Brucellosis is a characterized zoonotic disease by multisystem involvement. Although musculoskeletal involvement is the most frequent case, the pulmonary system is rarely involved. Nodular involment is one of the rarest amoung pulmonary involvements. This study presents a 21- year-old-male with pulmonary involvement without any musculoskeletal system involvement and he was received a diagnosis in the early days of hospitalization. Case: The patient had complaints of one -month-long cough and sputum production and he informed that he used different antibiotics. After the last center he went detected hypogonadism in the patient, he was referred to our hospital`s endocrinology clinic. Physical examination showed fever:37.2,nb:112 beats/min and fi ndings in accordance with the hypogonadism and also late inspiratory crackles had been heard by oscultation. The captured chest radiograph indicated suspicious nodular appearance and suspected infi ltrated area. The laboratory tests erythrocyte sedimentation rate:41mm/saat,C-Reactive Protein:14.1,WBC : 4.08 x103/ul. The patient stated that he was working as a village shephard 1 month ago who did not suffer from signifi - cant weight loss nor fever. Detailed medical history stated that the last examination indicated brucella rosebengal positive, and the antiglobulin (coombs) test in brucellosis 1/160 was also positive. Altough the sputum culture and tuberculosis acid fast stain were negative, the patient had a positive blood culture regarding brucella melitensis. The thorax CT image showed nodules in the lungs with the ground glass opacity and infi ltrative image has been detected in subpleural area. There was nothing in bones scintigraphy. The patient was treated rifampicin 1x600 mg and doxycycline 2x100 mg for 6 weeks. Along with the treatment the patient`s complaints disappeared, and post-treatment blood cultures was negative. Control thorax CT reveals disappearanceof lesions in the lung area. Conclusion: Anamnesis and disease suspicion are the most important things regarding diagnosis of Brucellosis.

Polyglandular Autoimmune Syndrome Type-Ii Presented with Acute Renal Injury

( Veysel Ozalper ),( Ibrahim Cetindagli ),( Omer Tekin ),( Yalcin Onem ),( Yusuf Hancerli ),( Eylem Cagiltay ),( Barbaros Basbug ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Polyglandular autoimmune syndrome (PAS) is a rare disease, characterized by failure of more than two endocrine glands. Type-II of this syndrome is the most common of the immunoendocrinopathy syndromes and characterized by the obligatory occurrence of autoimmune Addison disease in combination with thyroid autoimmune diseases and/or type-I diabetes mellitus. We report a case of PAS-TypeII presented with prerenal acute renal failure. Case Report: A twenty-two-year-old man had a hyperpigmentation of gingiva within three months, fatigue and amnesia within two months, emesis and vomit within one months, admitted because of persistent vomiting and ten kilogram weight loss. Initial laboratory fi ndings were: urea:87mg/dl, kreatinin:1.31mg/dl, sodium:125mmol/L, potassium: 5.6mmol/L, albumin:4.16g/dl, calcium:123mg/dl. In his arterial blood gas analyse, he had a normal anion gap metabolic asidosis. pH:7.24, HCO3:12.8mEq/L, pCO2:30mm- Hg. He had a prerenal acute renal injury because of persistent vomiting. Other laboratory fi ndings were Hemoglobine:12.9g/dl, TSH:0,004 uIU/ml, FreeT4:2,16ng/dl, Anti-TPO:876 IU/ml, AntiThyroglobulin:9,72IU/ml, Cpeptid:0,27ng/ml, Kortizol:0,1ug/dl, ACTH:22,8pg/ml, HbA1c: %4,7.. A thyroid-scintigraphy showed diffuse homogenous thyroid involvement. His pituitary magnetic-resonance-imaging, thoracoabdominal- tomography and esophagogastroscopy was normal. Based on his fi ndings above and intravenous ACTH stimulation test, adrenal insuffi ency and otoimmune thyroiditis were diagnosed. General condition improved gradually following the administration of hydrocortisone, fl udrocortisone, thyromazol, propranolol. Conclusions: As a conclusion, in persistant vomiting patients, endocrine functions must be performed. A patient who presents with a single autoimmune diseases must be considered at risk of other autoimmune diseases. High index of suspicion, early recognition and treatment can be life-saving, particularly when there is adrenal and thyroid component.