Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.

Ibuprofen is widely used in the community to manage pain, inflammation and fever. In cases of prolonged and supratherapeutic ingestion of ibuprofen, renal tubular acidosis (RTA) with profound hypokalemia may occur. Although hypokalemia is known to cause rhabdomyolysis, rhabdomyolysis occurring in the setting of ibuprofen-induced RTA is rare. We present an unusual case of a 34-year-old male who presented with rhabdomyolysis in the setting of profound hypokalemia as a result of ibuprofen-induced RTA. The patient was successfully treated with fluid resuscitation, electrolyte replacement and supportive therapy. This case demonstrates a serious complication of ibuprofen and the importance of monitoring in nonprescription medications.

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Introduction: Anti-glomerular basement membrane (GBM) disease is a rare condition that often presents as severe glomerulonephritis and pulmonary hemorrhage. Heparin-induced thrombocytopenia (HIT) is a wellknown but uncommon complication of heparin exposure that is characterized by autoantibodies against platelet factor 4 (PF4)/heparin complexes. Although these conditions are well described in the literature, the coexistence of HIT and anti-GBM glomerulonephritis is extremely rare. Case Report: We present a case of a 59-year-old gentleman with newly diagnosed anti-GBM glomerulonephritis who was treated with plasmapheresis and subsequently developed HIT with a delayed manifestation. Conclusion: This case demonstrates an interesting example of poly-autoimmunity and highlights the importance of platelet monitoring in patients with heparin exposure undergoing plasmapheresis.