－S 279 －
￭ S-433 ￭
A case of ileovesical fistula in patient with Cronh’s disease
전북대학교병원 신장내과
*김승범, 이식, 박성광, 강경표, 김원
Crohn’s disease is the most common cause of ileovesical fistula. The hallmarks of diagnosing fistula to the urinary system are pneumaturia, fecaluria, and recurrent or persistent urinary tract infections. Several diagnostic tests have been used to confirm clinical suspicion, which include endoscopic procedures and radiographic studies. A 19-year-old man visited our clinic with dysuria, pneumaturia, and fecal materials in urine. He had a history of recurrent cystitis for 5 months. The abdomen was soft with mild suprapubic tenderness. The laboratory findings showed a white blood cell count of 6,100/mm3, hemoglobin level of 9.3 g/dl, blood urea nitrogen level of 13 mg/dl, and creatinine level of 0.74 mg/dl. Urinalysis revealed 25-30 white blood cells per high-power field and 5-9 red blood cells per high-power field. Cystographic findings disclosed the communication between bowel and bladder. Colonoscopy showed multiple aphthous ulcers and pus-like discharge with fistula in ileocecal valve area. The urine culture contained Escherichia coli. Colonoscopic biopsy showed the findings of Crohn’s disease.
Cystoscopic findings disclosed abnormal erythematous mucosal lesion and polypoid mass like lesions in right bladder wall. The result of cystoscopic biopsy was compatible with chronic cystitis. CT scan showed thickening of the bladder wall, ileovesical fistula, and air in the bladder indicating presence of communication with ileum. Our patient was treated with infliximab to induce remission of Crohn’s disease. After four cycles of infliximab treatment, the activity index of Crohn’s disease decreased and clinical appearance was improved. In conclusion, clinicians should be aware of the index of suspicion (pneumaturia and fecaluria) and use of diagnostic tests (cystoscopy, colonoscopy, and CT scan) for appropriate diagnosis and treatment of enterovesical fistulas).
￭ S-434 ￭
Hypokalemic quadriplegia due to renal tubular acidosis associated with Secondary Sjögren syndrome and SLE
1Department of Internal Medicine, Division of Nephrology, Soonchunhyang University Cheonan Hospital,
2Department of Clinical Pathology, Catholic University
*Ji-Hyun Kim, MD
1, Su-Ji Kim, MD
1, Hyo-Wook Gil, MD
1, Jong-Oh Yang, MD
1, Eun-Young Lee, MD
1, Sae-Yong Hong, MD
1, Sun-Ah Nam
2, Wan-Young Kim, PhD
2, Jin Kim, MD
2Distal RTA occurred by impairment of hydrogen iron secretion in the collecting tubule, and it is accompanied by severe hypokalemia and metabolic acidosis. Genetic factor, connective tissue disease and drugs were causative factors of distal RTA, above all Sjögren syndrome is one of well known cause for distal RTA,it is defined as chronic inflammatory disease characterized by diminished lacrimal and salivary gland function.We present a 25-year-old woman who came to hospital by sudden quadriparesis.She had arthritis on left ankle and complained dry mouth for more than 1 year.On lab finding,K was 1.6 mEq/l with severe metabolic acidosis,SerumAG was 16,UrineAG was 14.1.With clinical features and lab finding, we considered distal RTA which arising from connective tissue disease.ANA was positive, Anti-dsDNA antibody,SS-A/RO and SS-B/La antibody were all positive.Schirmer test and minor salivary gland biopsy revealed Sjögren syndrome.Renal biopsy showed mesangial lupus nephritis (class II).This case revealed distal RTA which occurred as an extraglandular feature of Sjögren syndrome.Many cases of hypokalemic paralysis with Sjögren syndrome had been reported, but in this case SLE was accompanied as well.SLE may progressed to lupus nephritis and combined with Sjögren syndrome followed by hydrogen iron secretion dysfunction and potassium wasting due to tubular and renal parenchyme damage,which resulted as distal RTA.It is the first reported case that distal RTA appeared as first symptom with both Sjögren syndrome and SLE.
