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首页> 外文期刊>Hemodialysis international >A maintenance hemodialysis diabetic patient with unexplained pulmonary and gastrointestinal involvement
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A maintenance hemodialysis diabetic patient with unexplained pulmonary and gastrointestinal involvement

机译：维持性血液透析糖尿病患者，原因不明的肺和胃肠道受累

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A 50-year-old man with diabetes mellitus with diabetic retinopathy, peripheral neuropathy, hypertension, and end-stage renal disease on maintenance hemodialysis, presented with persistent cough and hiccups, continued to be unwell with weight loss, poor appetite, and recurrent respiratory symptoms such as wheezing and cough. Whole body positron emission tomography-computed tomography scan showed metabolically active lesions in liver, stomach/lesser sac, pancreas, and left sixth rib. As he had repeated bilateral transudative pleural effusion, left mini thoracotomy with pleural biopsy showed no evidence of granuloma or malignancy. Upper gastroscopy showed tiny gastric polyp; biopsy revealed benign lesion. Left posterior rib biopsy from the lesion and iliac crest biopsy showed no evidence of malignancy or granuloma. Further evaluation showed plasma chromogranin A -5737g/L (<100g/L) with a repeat value of 6950g/L (<100g/L). He was initiated on oral sunitinib 25mg once a day and injection octreotide 20mg subcutaneously once a month. The plasma chromogranin A level and his symptoms, however, showed an initial improvement, but gradually worsened after 4 months despite being on treatment. After 6 months, the patient developed a gangrenous lesion of his glans penis with necrosis. Due to severe pain on conservative measures, penectomy with perineal urethrostomy was performed. Biopsy of the lesion showed blood vessels with intimal calcifications and thrombosis suggesting penile necrosis.
机译：一名患有糖尿病性视网膜病变，周围神经病变，高血压和终末期肾脏疾病且维持性血液透析的50岁糖尿病患者，伴有持续咳嗽和打,，但体重持续下降，食欲不振和反复呼吸喘息和咳嗽等症状。全身正电子发射断层扫描计算机断层扫描显示肝脏，胃/小囊，胰腺和左第六肋有代谢活跃的病变。由于他反复进行双侧渗出性胸腔积液，左小切口胸腔穿刺术并进行了胸膜活检未显示肉芽肿或恶性肿瘤的迹象。上消化道胃镜检查可见胃息肉细小。活检显示良性病变。病变左侧and骨后活检和骨活检均未显示恶性或肉芽肿的迹象。进一步评估显示血浆嗜铬粒蛋白A -5737g / L（<100g / L），重复值为6950g / L（<100g / L）。他每天口服一次口服舒尼替尼25mg，每月一次皮下注射奥曲肽20mg。然而，血浆嗜铬粒蛋白A水平和他的症状显示出初步的改善，尽管接受了治疗但在4个月后逐渐恶化。 6个月后，患者的龟头阴茎出现坏死性坏死病灶。由于采取保守措施引起的剧烈疼痛，因此进行了会阴部尿道造瘘术。病变活检显示血管内膜钙化和血栓形成，提示阴茎坏死。

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