Amyloidosis is a disorder characterized by accumulation of B sheet misfolded proteinosis, amorph material at extracellular matrix. Amyloidosis is a serious disease that can cause mortality and severe morbidity with organ involvement especially kidney, heart, nerve, and spleen. Amyloidosis must be kept in mind particularly when multiorgan involvement occurs. In our case 1.5 months later after thyroid operation, our patient admitted with oedema, creatinine, blood urea nitrogen elevation and massive proteinurea. We suspected nephrotic syndrome and in his past thyroidectomy specimen reexamination amyloid aggregation was detected. It is an interesting case because of AA secondary type of amyloidosis involvement in thyroid tissue is rare and being diagnosed from past thyroidectomy specimen staining instead of making new organ tissue biopsies.KEy words: Amyloidosis, Nephrotic syndrome, Proteinuria, Thyroid amyloidosis ÖzAmiloidoz vücuttaki birçok organ ve dokuda ekstrasellüler alanda B kıvrımlı tabaka yapısı oluşturan amorf, proteinöz yapıda materyal birikimi ile karakterize bir hastalıktır. Amiloidoz başta kalp, böbrek, dalak, ve sinir gibi bir çok organ ve doku tutulumu ile birlikte mortalite ve önemli morbiditelere neden olabilen ciddi bir hastalıktır. Amiloidoz özellikle birden çok organ tutulumu tespit edildiğinde her zaman tanı olarak düşünülmeli ve uygun bir dokudan biyopsi materyalinin patolojik incelemesi yapılmalıdır. Olgumuz bir buçuk ay önce tiroid operasyonu sonrası ciddi ödemleri sebebiyle doktora başvuran kan üre azotu ve kreatinin yükselmesiyle birlikte masif proteinüri saptanmasıyla nefrotik sendrom düşünülen ve yapılmış olan tiroidektomi biyopsi materyalinde amiloid depolanması tespit edilen bir hastadır. AA tipi sekonder amiloidin tiroid tutulumu olması ve tanının tiroid biyopsi materyalinden konması ile sık görülen dokular dışında da görülebilmesi açısından ilginç bir olgudur.

No abstract

ÖZET Halk arasında melek borusu, şeytan elması, boru çiçeği, cin otu, tatula, sihirbaz otu olarak da bilinen Datura stramonium bitkisi, görüntüsünün güzel olması nedenli Türkiye'de sık yetiştirilmekle birlikte zehirli olduğu yeterince bilinmemektedir. Bitki etken maddesi olarak tropan grubu alkaloitlerden hiyosiyamin, skopolamin ve atropin içermekte olup, zehirlenmelerinde antikolinerjik etkiler olabilmektedir. Bitkinin her tohumu ortalama 0,65 mg skopolamin ve 0,3 mg atropin içermektedir. Atropinin 10 mg ve üzeri dozlarında ölüm görülebilmektedir. Bu çalışmada, antikolinerjik semptomlarla acile başvuran ve yoğun bakımda takip edilen sonrasında Datura stramonium bitkisini yedikleri anlaşılan 2 kişilik bir ailenin sunulması amaçlanmıştır. Bu çalışma ile antikolinerjik semptomlarla gelen hastalarda bu bitkinin alımının sorgulanması gerektiği hatırlatılmak istenmiştir.Anah tar Ke li me ler: Datura stramonium; zehirlenme; antikolinerjik sendrom; kolinerjik antagonistler ABS TRACT Datura stramonium, also known as pipe flower, devil's apple, angel's trumpet, demon's plant, tatula, sorcerer's plant, is cultiveted widely in Turkey because of its beauty but its toxicitiy is not known enough. The plant contains several alkaloids such as atropine, hyaline and scopolamine and anticholinergic symptoms are seen by toxication of this plant. Each blossom of plant contains nearly 0.65 mg scopolamine and 0.3 mg atropine and fatalities have been reported at an atropine dose of 10 mg. In this article, we report the poisoning of 2 family member who ate Datura stramonium as dinner and presented to the emergency service with anticholinergic symptoms and follwed at intensive care unit. By this report, we want to emphasise that Datura stramonium must be remembered by clinicans in patients who present with anticholinergic symptoms.

Rhabdomyolysis is a condition of muscle tissue release including after necrosis of muscle due to a direct or indirect muscle injury. Rhabdomyolysis is mostly asymptomatic but hypovolemic shock, cardiac arrhythmias or acute renal failure may be seen afterwards. Herein, we presented two rare cases of rhabdomyolysis; a patient who developed acute kidney injury associated with rhabdomyolysis following an epileptic seizure and a patient who developed acute kidney injury associated with rhabdomyolysis following swimming. With these rare cases, we wanted to emphasize that epileptic seizures and excessive exercise such as swimming may cause rhabdomyolysis just like the well-known causes. Early treatment of rhabdomyolysis is very important and should be suspected if findings of rhabdomyolysis are seen after these events.

Heavy proteinuria and nephrotic syndrome may occur in association with a wide variety of primary and systemic diseases and also with drugs. Major drugs that can induce nephrotic syndrome and glomerular damage are gold, penicillamine, bucillamine and non-steroidal anti-inflammatory drugs. In nephrotic syndrome due to these drugs, the major type of renal disease is membranous glomerulonephritis and the nephropathy resolves completely when the drug is withdrawn. Here we report a patient who developed nephrotic syndrome after the initiation of metformin. Laboratory parameters improved rapidly after the discontinuation of the drug. Our case is important as it is the first case with nephrotic syndrome due to metformin in the literature.