title: A syndrome of inappropriate secretion of antidiuretic hormone associated with pleuritis caused by OK-432.
abstract: We here report a case presenting with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after having been treated for pleurodesis with OK-432, which is a lyophilized preparation of an attenuated strain of Streptococcus pyogenes. The patient, who had undergone a subtotal esophagectomy 4 years previously, was referred to our department after the diagnosis of a metastatic lung tumor. A right lower lobectomy of the lung was performed, and prolonged air leakage from a pulmonary fistula thereafter developed because of the dissection of severe pleural adhesion. OK-432 (5 klinische einheiten) was administered to the pleural cavity 3 times. On the 13th postoperative day, the patient began to complain of general fatigue and nausea. SIADH was diagnosed based on laboratory findings such as hyponatremia, serum hypo-osmolality and a high excretion of sodium in the urine. A restriction of the fluid intake with a sodium supplement resulted in the return to a normal serum level within 2 weeks. We therefore concluded that the intrapleural instillation of OK-432 had apparently caused SIADH in this case, because no other causes could be found.
authors.affiliation: Department of Chest Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hanagiri
authors.forename: H
authors.initials: H
authors.lastname: Muranaka
authors.forename: M
authors.initials: M
authors.lastname: Hashimoto
authors.forename: A
authors.initials: A
authors.lastname: Nagashima
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008171:Lung Diseases / Q000209:etiology / Q000628:therapy*; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D010844:Picibanil / Q000008:administration & dosage / Q000009:adverse effects*; D010995:Pleural Diseases / Q000209:etiology; D018700:Pleurodesis / Q000009:adverse effects*; D011013:Pneumonectomy / Q000009:adverse effects; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy*; D000267:Tissue Adhesions / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010844:Picibanil