{"id":197,"date":"2017-12-26T08:17:28","date_gmt":"2017-12-26T08:17:28","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/fg\/?p=197"},"modified":"2017-12-26T08:17:28","modified_gmt":"2017-12-26T08:17:28","slug":"thoracic-and-abdominal-pain-in-a-28-year-old-woman-with-a-failing-kidney-transplant","status":"publish","type":"post","link":"http:\/\/stg-blogs.bmj.com\/fg\/2017\/12\/26\/thoracic-and-abdominal-pain-in-a-28-year-old-woman-with-a-failing-kidney-transplant\/","title":{"rendered":"Thoracic and abdominal pain in a 28-year old woman with a failing kidney transplant"},"content":{"rendered":"<p>A 28-year old woman with a failing kidney transplant due to rejection (on high dose Prednisolone and Alemtuzumab) presented with increasing right-sided thoracic pain and abdominal discomfort. Physical examination revealed no abnormalities. Laboratory results showed a normal white blood cell count, low serum C-reactive protein, normal level of liver enzymes and electrolytes, an elevated serum creatinine of 335 \u03bcmol\/L consistent with known chronic kidney transplant failure and a mildly elevated lipase of 360 U\/L. Initial diagnostic workup excluded a pulmonary embolism, pneumonia, cardiac ischaemia, urinary tract infection, choledocholithiasis and cholecystitis. In the days following admission the patient developed intense epigastric pain and serum lipase increased to &gt;3x upper limit of the reference range (3002 U\/L). Oesophago-gastro-duodenoscopy showed mild antrum gastritis and multiple small white lesions (Figure 1). A CT scan of the abdomen showed multiple pancreatic cysts (Figure 2), and nodular densities with ground glass consolidations in the included basal lung fields (Figure 3).<\/p>\n<p>Arrows denote the relevant lesions.What is the unifying diagnosis?<\/p>\n<p><a href=\"https:\/\/stg-blogs.bmj.com\/fg\/files\/2017\/12\/PK-Dec-17-1.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-199\" src=\"https:\/\/stg-blogs.bmj.com\/fg\/files\/2017\/12\/PK-Dec-17-1-300x225.png\" alt=\"\" width=\"300\" height=\"225\" srcset=\"http:\/\/stg-blogs.bmj.com\/fg\/files\/2017\/12\/PK-Dec-17-1-300x225.png 300w, http:\/\/stg-blogs.bmj.com\/fg\/files\/2017\/12\/PK-Dec-17-1.png 720w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>Kirill Pavlov1, Parweez Koehestanie1, Jaap J. Beutler2, Tessa E. H. R\u00f6mkens1, Ellen K. Hoogeveen2, Loes H.C. Nissen1<\/p>\n<p>1 Department of gastroenterology and hepatology, Jeroen Bosch Ziekenhuis (Jeroen Bosch hospital) Den Bosch, the Netherlands<\/p>\n<p>2 Department of internal medicine, Jeroen Bosch Ziekenhuis (Jeroen Bosch hospital) Den Bosch, the Netherlands<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 28-year old woman with a failing kidney transplant due to rejection (on high dose Prednisolone and Alemtuzumab) presented with increasing right-sided thoracic pain and abdominal discomfort. Physical examination revealed no abnormalities. Laboratory results showed a normal white blood cell count, low serum C-reactive protein, normal level of liver enzymes and electrolytes, an elevated serum [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"http:\/\/stg-blogs.bmj.com\/fg\/2017\/12\/26\/thoracic-and-abdominal-pain-in-a-28-year-old-woman-with-a-failing-kidney-transplant\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-197","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/posts\/197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/comments?post=197"}],"version-history":[{"count":0,"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/posts\/197\/revisions"}],"wp:attachment":[{"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/media?parent=197"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/categories?post=197"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/fg\/wp-json\/wp\/v2\/tags?post=197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}