The McKittrick-Wheelock syndrome: a case of acute renal failure due to neoplastic cholera.
The McKittrick-Wheelock syndrome is characterized by severe electrolyte and fluid depletion as a result of rectal tumor hypersecretion. Typically, a metabolic acidosis ensues. We report the case of a 58-year-old man who presented with a mixed metabolic acidosis and alkalosis. He was hyponatremic, hypokalemic, and hypochloremic, with acute renal failure on blood testing. Following fluid resuscitation, a predominant alkalemia was observed. The patient was found to be passing 1.5 L of mucous per rectum per day, containing high concentrations of sodium and potassium, similar to that observed in cholera stool. A large rectal villous adenoma was discovered on sigmoidoscopy, and definitive management was achieved by removal of the tumor. This case provides a demonstration of the ranging metabolic disturbance associated with secretory diarrhea. Other endogenous and infective causes are discussed, and mechanisms compared with the case described.
Department of Endocrinology, Imperial College Healthcare NHS Trust, and Imperial College Faculty of Medicine, London, UK.
Virginia
V
Winstanley
Mark A
MA
Little
Christopher
C
Wadsworth
Patrizia
P
Cohen
Niamh M
NM
Martin
D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D018253:Adenoma, Villous / Q000150:complications / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D002771:Cholera / Q000150:complications*; D003082:Colectomy / Q000379:methods; D003113:Colonoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000150:complications / Q000175:diagnosis* / Q000628:therapy