Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
Int Urol Nephrol. 2012 Feb;44(1):315-8. doi: 10.1007/s11255-010-9855-z. Epub 2010 Oct 16.
A 32-year-old gentleman was attacked by honey bees about 8 months and immediately afterwards his eyelids, cheeks and pinnae became swollen, red, and tender. However, the patient did not develop any renal or serum sickness symptoms and his physical examination and laboratory investigations were normal. He recovered completely. A week later, while working on his farm, he experienced a sudden loss of muscular tone in all four limbs without losing his consciousness. The medical examination subsequently revealed flaccid quadriparesis associated with a serum potassium of 2.1 mEq/L. He was also found to have hyperchloremic metabolic acidosis with normal anion gap and preserved ability to acidify urine to a pH of 5.5. These findings were suggestive of proximal renal tubular acidosis (Fanconi syndrome). Other abnormalities like hypophosphataemia, hypouricemia, renal glucosuria and high urinary excretion of calcium, phosphorus and uric acid further supported the diagnosis of proximal tubular dysfunction. The renal biopsy revealed dense lymphocytic interstitial infiltrate, a feature often seen in Sjogren's syndrome, in which at least 50% of patients fail to acidify urine. In our patient, thorough search for other causes of proximal renal tubular acidosis was negative.
一位 32 岁的男性绅士大约 8 个月前被蜜蜂袭击，随后他的眼睑、脸颊和耳廓肿胀、发红、变得娇嫩。然而，该患者未出现任何肾脏或血清病症状，体格检查和实验室检查均正常。他完全康复了。一周后，他在农场工作时突然四肢无力，意识清醒。随后的医学检查发现血清钾为 2.1mEq/L，伴有弛缓性四肢瘫痪。他还患有高氯性代谢性酸中毒，正常阴离子间隙，且尿液酸化至 pH 值 5.5 的能力正常。这些发现提示近端肾小管酸中毒（范可尼综合征）。其他异常，如低磷血症、低尿酸血症、肾性糖尿以及钙、磷和尿酸的高尿排泄，进一步支持近端肾小管功能障碍的诊断。肾活检显示致密的淋巴细胞间质浸润，这是干燥综合征的常见特征，其中至少 50%的患者无法酸化尿液。在我们的患者中，对近端肾小管酸中毒的其他原因进行了彻底的搜索，结果为阴性。
