A 65-year-old man with a 20-year history of rheumatoid arthritis was transferred to our hospital due to a second episode of intestinal obstruction, a fever, and joint pain within the previous 6 months. He had an extremely high rheumatoid factor level and decreased complement levels. Abdominal computed tomography, a small bowel series, and small intestinal endoscopy revealed severe ileal stenosis. Resection of the stenotic lesion was performed, and a histopathological examination revealed vasculitis. Rheumatoid vasculitis was diagnosed, and the patient began treatment with prednisolone and methotrexate, which improved his condition. Rheumatoid vasculitis is a rare, but possible cause of recurrent bowel obstruction.
Objective: Rhabdomyolysis is a serious syndrome which may lead to acute kidney injury and even death. However, reliable factors for predicting the prognosis of this condition, especially regarding patient's physical findings, remain to be clarified.
Methods:We retrospectively analyzed charts of patients who were clinically suspected of rhabdomyolysis with high serum creatine kinase on admission to the Department of General Medicine, Saga University Hospital, Japan from 2006-2013. Patients were divided into two groups, those progressing to serious consequences of death or acute kidney injury requiring renal replacement therapies during hospitalization (Group A) and those not progressing to such conditions (Group B). We compared background characteristics, symptoms, signs, and blood chemistry between both groups.Results: A total of 53 Japanese patients were enrolled (men, 60.4%; mean age 58.6 years). Group A consisted of five cases. According to univariate analysis, only the finding of excessive sweating on admission was related to the serious consequences (odds ratio 31.33, 95% confidence interval 2.17-450.07, p<0.05).
Conclusions:Excessive sweating on admission is a useful indicator to predict the prognosis of serious consequences of rhabdomyolysis.
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