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[Decrease in general health status, febrile state and sinusitis in renal insufficiency].

A de Torrenté1, L Guillou

  • 1Département de médecine interne, Faculté de médecine, Université de Lausanne.

Schweizerische Medizinische Wochenschrift
|September 19, 1992
PubMed
Summary
This summary is machine-generated.

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This case study describes a patient with chronic renal failure, hypertensive heart disease, and anemia who developed a carcinoid tumor. The patient experienced severe, multi-systemic complications including sinus and eye involvement, ultimately succumbing to his illness.

Area of Science:

  • Nephrology
  • Oncology
  • Infectious Diseases

Background:

  • A 59-year-old male with a 9-year history of chronic renal failure requiring dialysis, hypertensive cardiopathy, and anemia presented with complex medical issues.
  • The patient had received over 70 units of blood and was treated with desferrioxamine for elevated blood aluminum levels.

Observation:

  • An intestinal lesion was discovered after melena episodes, with elevated serotonin levels and liver biopsy findings suggestive of a carcinoid tumor or pancreatic islet cell tumor.
  • The patient developed ascites, edema, fever, and a gingival abscess, with Klebsiella pneumoniae identified in blood cultures.

Findings:

  • Despite treatment, the patient experienced recurrent fever, myalgias, eyelid edema, maxillary pain, and a necrotic nasal lesion.
  • Ophthalmological findings included sudden blindness with retinal ischemia, elevated sedimentation rate, prompting suspected temporal arteritis treatment.

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Implications:

  • The case highlights the diagnostic challenges of multi-systemic manifestations in patients with underlying chronic diseases and malignancy.
  • Differential diagnoses for the terminal illness included lethal midline granuloma, Wegener's granuloma, lymphomas, and infectious etiologies.
  • The discussant accepted diagnoses of hypertensive cardiopathy, renal failure, and metastatic carcinoid, while questioning the role of iron overload and exploring causes for the terminal manifestations.