A 46-year-old man who had been suffering from palmoplantar pustulosis (PPP) for 3 years had anterior chest pain and left temporal pain from six months after the onset of his disease. A bone scan revealed abnormal uptake at the sternoclavicular joint and left temporal region. The head CT and MRI gave the diagnosis of temporal osteomyelitis with meningitis and myositis. His headache continued even after tonsillectomy and was effectively treated with cyclosporine A (3 mg/kg/day). Oral cyclosporine A was beneficial for the osteomyelitis and skin lesions. Sterile lytic bone lesions occurring most often at the sternocostoclavicular joint have been associated with PPP. However, there have been no reports of a PPP patient with temporal osteomyelytic involvement.
It has been generally assumed that contrast media used for excretory urography are safe even in the presence of renal insufficiency. Recently, however, several reports of acute oliguric renal failure have been documented in diabetic patients after excretory urography. Wealso have experienced three cases of acute renal failure following contrast media study in diabetic patients. For the purpose of investigating the effect of contrast media on renal function, we examined serum creatinine, BUN,K+levels and urine volume before and after intravenous pyelography (IVP) , drip-infusion pyelography (DIP) or angiography in twenty diabetic patients. As controls, twenty patients with non-diabetic renal diseases were selected. From this study, it is concluded that contrast media study had better be avoided in diabetic patients providing with renal disturbance (creatinine level more than 3.0 mg/dl) and severe retinopathy.
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