The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 393
Poster Session
PS 1534 Rheumatology
Carpal Tunnel Syndrome Associated with Tophaceous Deposition in Flexor Digitorum Tendons
Jong Sik Lee1, Se Woong Kwon1, Ji Hye Kim1, Ho-Youn Kim1, Hae-Rim Kim1, Sang- Heon Lee1
Konkuk University Medical Center, Korea1
Carpal tunnel syndrome is the most common peripheral entrapment neuropathy, which is caused by various local diseases such as tendinitis, tenosynovitis, arthritis, fracture, space-occupying lesions and intrinsic nerve lesions, as well as systemic and mechanical causes. Here, we report the fi rst Korean case of carpal tunnel syndrome induced by to- phaceous deposition of fl exor digitorum tendons in patients with chronic tophaceous gout. A 63 year-old male was suffered from the numbness and decreased sensation of both thumbs and second, third, and fourth fi ngers and thenar muscle weakness for 3 years. On physical examination, there were positive Tinel and Phalen signs and thenar muscle atrophy in both hands. In nerve conduction study, there was the loss of sensory and motor nerve action potentials in bilateral median nerves. Ultrasonog- raphy showed increased cross sectional area of median nerves at the proximal carpal tunnels and the compression of the median nerves due to tophaceous deposition of fl exor digitorum tendons in the carpal tunnels of both hands. Dual-energy computed tomography showed diffuse multifocal green color coding tophaceous depositions in the fl exor digitorum and fl exor pollicis longus tendons, metacarpophalangeal joints, transverse carpal ligament and subcutaneous tissues. His neuropathic symptoms were improved after injection of triamcinolone into the carpal tunnel and symptomatic oral medication including non-steroidal anti-infl ammatory drugs and colchicine.
PS 1535 Rheumatology
A Case of Fanconi Syndrome with Low-Dose Adefo- virdipivoxil Treatment
Young Wook Kim1, In-Woon Baek1
The Catholic University of Korea, Yeouido St. Mary`s Hospital, Korea1
Adefovirdipivoxil (ADV), antiviral agent is known that have nephrotoxicity and renal tubular impairment depending on dose and period. Although these side effects were common for HIV patient, high dose, chronic hepatitis B patients are known to be free from these side effects due to low dose therapy. Though, because most patients intak- ing low dose adefovir show low level of phosphate, it is risky to overlook possiblity of Fanconi syndrome, proximal tubule injury. Here we report a case of Fanconi syndrome, caused by low dose adefovir and intend to emphasize importance of monitoring phos- phate level regularly. A 52-year old woman complained multiple pains, which fi nely were not located and started 1 year ago. She visited several hospitals, but could not get a diagnosis. As the time to go, the pain was worse and eventually had diffi culty to walk and stand. We checked Bonescan(fi g 1) and simple x-ray, which showed multiple fractures. After admission, Lab data revealed severe hypophosphatemia, hypokalemia with metabolic acidosis, glucosisuria, hypoproteinemia. Taking History, she have been taking adefovir dipivoxil 10mg and entecavir 0.1mg since 2011. We did a bicarbo- nate loading test(table 1), confi rmed proximal tubule injury. We disgnosed Fanconi syndrome, proximal tubule injury due to adefovir. After quiting the ADV, she was dis- charged. After 20days, she visited out patient department and her blood test showed normal phosphate ad potassium level and symptom improved also.
