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Renal Lymphoma and Human Immunodeficiency Virus Infection: In response
Mayo Clio Proc, December 1995, Vol 70
LEITERS
the clinical suspicion of HIV positivity in any patient with even a remote possibility of infection. Juan F. Navarro, M.D. Hospital Ntra. Sra. de Candelaria Tenerife, Canary Islands F. Liafio, M.D. Hospital Ramon y Cajal Madrid, Spain REFERENCES I. Cohen AH, Nast Cc. Pathology of the kidneys. In: Nash G, Said JW, editors. Pathology of AIDS and HIY infection. Philadelphia: Saunders, 1992: 130-147 2. van Gelder T, Michiels JJ, Mulder AH, Klooswijk AI, Schalekamp MA. Renal insufficiency due to bilateral primary renal lymphoma. Nephron 1992; 60: 108-110 3. Centers for Disease Control. Revision of the case definition of acquired immunodeficiency syndrome for national reporting-United States. MMWR Morb Mortal Wkly Rep 1985; 34:373-375 4. Navarro JF, Liafio F, Garcia Larafia J, Garcia Gonzalez R, Pascual J, Ortufio J. Lymphomatous infiltration of the kidneys as presentation of acquired immunodeficiency syndrome. Nephrol Dial Transplant 1994; 9:175-177
In response: The comments from Drs. Navarro and Liafio about our article are appreciated. I agree that the atypical manifestation of extranodallymphoma involving uncommon sites, such as the kidneys, should trigger a suspicion of human immunodeficiency virus infection. W. P. Daniel Su, M.D. Mayo Clinic Rochester Rochester, Minnesota
Causes of Rhabdomyolysis To the Editor: I read with interest the article by Dr. Rizzieri entitled "Rhabdomyolysis After Correction of Hyponatremia Due to Psychogenic Polydipsia," which was published in the May 1995 issue of the Mayo Clinic Proceedings (pages 473 to 476). In that article, he attributed rhabdomyolysis to rapid correction of the patient's hyponatremia. I wonder why Dr. Rizzieri did not attribute it to the patient's psychotropic medicine, fluphenazine decanoate. It seems that a phenothiazine antipsychotic drug is more likely to cause this problem than is rapid correction of the hyponatremia. Gordon J. Rafool, M.D. Gessler Clinic Winter Haven, Florida
1225
In response: Dr. Rafool correctly points out the difficulty in determining causality based on clinical observations. The possibility of fluphenazine causing the muscle damage was considered; however, no reports have described this relationship, although eight reports have described other phenothiazines associated with rhabdomyolysis."" Two reports 1,2 noted several signs consistent with the neuroleptic malignant syndrome, a known cause of muscle damage. Unfortunately, not all the authors had an opportunity to observe their patients before the onset of symptoms; thus, the mechanism that caused the rhabdomyolysis is less obvious. In each of the reports, however, the patients had recently begun taking fenoverine, and discontinuation of use of that drug was considered an important part of the treatment. In one patient, use of the drug was reinstituted, and rhabdomyolysis promptly redeveloped. In contrast, my patient had been taking fluphenazine at the same dosage for years and still receives this treatment. He was closely observed in the hospital when his problems began, and he specifically had no leukocytosis, fever, spasms, or seizures consistent with the neuroleptic malignant syndrome. He continues to take the phenothiazine at the same dosage and has had no clinical or laboratory evidence of other recurrences of rhabdomyolysis. Although I cannot be unequivocally sure, the evidence presented in the case report strongly supports the conclusion that correction of the hyponatremia was the proximate cause of the rhabdomyolysis. David A. Rizzieri, M.D. Duke University Medical Center Durham, North Carolina REFERENCES 1. Reis J, Felten P, Rumbach L, Collard M. Hyperthermia with acute rhabdomyolysis in a psychotic treated with neuroleptics. Rev Neurol (Paris) 1983; 139:595-596 2. Denborough MA, Collins SP, Hopkinson KC. Rhabdomyolysis and malignant hyperpyrexia. BMJ 1984; 288:1878 3. Chichmanian RM, Fuzibet JG, Mignot G, Dujardin P. Acute rhabdomyolysis induced by fenoverine: 2 cases [letter]. Ann Med Interne (Paris) 1990; 141:490-491 4. Hebuterne X, Chichmanian RM, Cohen HL, Rampal P. Acute rhabdomyolysis due to fenoverine [letter]. Gastroenterol Clin Bioi 1991; 15:861-862 5. Dutertre JP, Asselin F, Jonville AP, Benhamou C, Autret E. Rhabdomyolysis with acute renal insufficiency caused by fenoverine [letter]. Ann Med Interne (Paris) 1991; 142:553-554 6. Benamouzig R, Chaussade S, Roche H, Aubert A, Fiessinger IN, Carlet J, et al. Acute rhabdomyolysis and necrotizing enterocolitis after ingestion offenoverine [letter]. Gastroenterol Clin Bioi 1992; 16:719720 7. Sultan S, Lesgourgues B, el Attar Y, Fauvelle F, Delas N. Acute rhabdomyolysis due to fenoverine (Spasmopriv): a case and review of the literature [letter]. Therapie 1992; 47:443 8. Hardin JM, Guillebaud JC, Lallement PY, Matta B, Andrejak M. Rhabdomyolysis associated to fenoverine therapy and complicated by acute renal failure [letter]. Therapie 1992; 47:165-166
The Editor welcomes letters and comments, particularly pertaining to recently published articles in the Mayo Clinic Proceedings. A letter should be no longer than 500 words, contain no more than 5 references, and be in a double-spaced, typewritten format. The letter should be signed. It is assumed that appropriate letters may be published, at the discretion of the Editor, unless the writer indicates otherwise. The Editor reserves the right to edit letters in accordance with the Mayo Clinic Proceedings style and to abridge them if necessary.
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
LEITERS
the clinical suspicion of HIV positivity in any patient with even a remote possibility of infection. Juan F. Navarro, M.D. Hospital Ntra. Sra. de Candelaria Tenerife, Canary Islands F. Liafio, M.D. Hospital Ramon y Cajal Madrid, Spain REFERENCES I. Cohen AH, Nast Cc. Pathology of the kidneys. In: Nash G, Said JW, editors. Pathology of AIDS and HIY infection. Philadelphia: Saunders, 1992: 130-147 2. van Gelder T, Michiels JJ, Mulder AH, Klooswijk AI, Schalekamp MA. Renal insufficiency due to bilateral primary renal lymphoma. Nephron 1992; 60: 108-110 3. Centers for Disease Control. Revision of the case definition of acquired immunodeficiency syndrome for national reporting-United States. MMWR Morb Mortal Wkly Rep 1985; 34:373-375 4. Navarro JF, Liafio F, Garcia Larafia J, Garcia Gonzalez R, Pascual J, Ortufio J. Lymphomatous infiltration of the kidneys as presentation of acquired immunodeficiency syndrome. Nephrol Dial Transplant 1994; 9:175-177
In response: The comments from Drs. Navarro and Liafio about our article are appreciated. I agree that the atypical manifestation of extranodallymphoma involving uncommon sites, such as the kidneys, should trigger a suspicion of human immunodeficiency virus infection. W. P. Daniel Su, M.D. Mayo Clinic Rochester Rochester, Minnesota
Causes of Rhabdomyolysis To the Editor: I read with interest the article by Dr. Rizzieri entitled "Rhabdomyolysis After Correction of Hyponatremia Due to Psychogenic Polydipsia," which was published in the May 1995 issue of the Mayo Clinic Proceedings (pages 473 to 476). In that article, he attributed rhabdomyolysis to rapid correction of the patient's hyponatremia. I wonder why Dr. Rizzieri did not attribute it to the patient's psychotropic medicine, fluphenazine decanoate. It seems that a phenothiazine antipsychotic drug is more likely to cause this problem than is rapid correction of the hyponatremia. Gordon J. Rafool, M.D. Gessler Clinic Winter Haven, Florida
1225
In response: Dr. Rafool correctly points out the difficulty in determining causality based on clinical observations. The possibility of fluphenazine causing the muscle damage was considered; however, no reports have described this relationship, although eight reports have described other phenothiazines associated with rhabdomyolysis."" Two reports 1,2 noted several signs consistent with the neuroleptic malignant syndrome, a known cause of muscle damage. Unfortunately, not all the authors had an opportunity to observe their patients before the onset of symptoms; thus, the mechanism that caused the rhabdomyolysis is less obvious. In each of the reports, however, the patients had recently begun taking fenoverine, and discontinuation of use of that drug was considered an important part of the treatment. In one patient, use of the drug was reinstituted, and rhabdomyolysis promptly redeveloped. In contrast, my patient had been taking fluphenazine at the same dosage for years and still receives this treatment. He was closely observed in the hospital when his problems began, and he specifically had no leukocytosis, fever, spasms, or seizures consistent with the neuroleptic malignant syndrome. He continues to take the phenothiazine at the same dosage and has had no clinical or laboratory evidence of other recurrences of rhabdomyolysis. Although I cannot be unequivocally sure, the evidence presented in the case report strongly supports the conclusion that correction of the hyponatremia was the proximate cause of the rhabdomyolysis. David A. Rizzieri, M.D. Duke University Medical Center Durham, North Carolina REFERENCES 1. Reis J, Felten P, Rumbach L, Collard M. Hyperthermia with acute rhabdomyolysis in a psychotic treated with neuroleptics. Rev Neurol (Paris) 1983; 139:595-596 2. Denborough MA, Collins SP, Hopkinson KC. Rhabdomyolysis and malignant hyperpyrexia. BMJ 1984; 288:1878 3. Chichmanian RM, Fuzibet JG, Mignot G, Dujardin P. Acute rhabdomyolysis induced by fenoverine: 2 cases [letter]. Ann Med Interne (Paris) 1990; 141:490-491 4. Hebuterne X, Chichmanian RM, Cohen HL, Rampal P. Acute rhabdomyolysis due to fenoverine [letter]. Gastroenterol Clin Bioi 1991; 15:861-862 5. Dutertre JP, Asselin F, Jonville AP, Benhamou C, Autret E. Rhabdomyolysis with acute renal insufficiency caused by fenoverine [letter]. Ann Med Interne (Paris) 1991; 142:553-554 6. Benamouzig R, Chaussade S, Roche H, Aubert A, Fiessinger IN, Carlet J, et al. Acute rhabdomyolysis and necrotizing enterocolitis after ingestion offenoverine [letter]. Gastroenterol Clin Bioi 1992; 16:719720 7. Sultan S, Lesgourgues B, el Attar Y, Fauvelle F, Delas N. Acute rhabdomyolysis due to fenoverine (Spasmopriv): a case and review of the literature [letter]. Therapie 1992; 47:443 8. Hardin JM, Guillebaud JC, Lallement PY, Matta B, Andrejak M. Rhabdomyolysis associated to fenoverine therapy and complicated by acute renal failure [letter]. Therapie 1992; 47:165-166
The Editor welcomes letters and comments, particularly pertaining to recently published articles in the Mayo Clinic Proceedings. A letter should be no longer than 500 words, contain no more than 5 references, and be in a double-spaced, typewritten format. The letter should be signed. It is assumed that appropriate letters may be published, at the discretion of the Editor, unless the writer indicates otherwise. The Editor reserves the right to edit letters in accordance with the Mayo Clinic Proceedings style and to abridge them if necessary.
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.