title: Recurrent epistaxis revealing a non-catheter-related superior vena cava syndrome in a hemodialysis patient: unmasking undifferentiated connective tissue disease.
abstract: We report a case of an 80-year-old Caucasian woman on maintenance hemodialysis for almost three years through a right-tunneled jugular catheter. She presented with recurrent epistaxis for which she was periodically blood transfused despite erythropoietin therapy. She continued manifesting epistaxis, which was progressively emerging as a sign related to superior vena cava syndrome due to mediastinal mass. Laboratory investigations revealed active immunological abnormalities thereafter. Malignant superior vena syndrome remains an uncommon com-plication in this population related to a history of or ongoing central vein catheterization. Prolonged oozing from the vascular site was the first alerting sign of the existence of this syndrome. We conclude that sometimes the transformation of undifferentiated connective tissue disease in the presence of epidermoid carcinoma of the superior mediastinum may be revealed during the use of catheters in dialysis.
authors.affiliation: Department of Nephrology and Dialysis, Louis Jaillon General Hospital, Saint Claude, France.
authors.forename: O
authors.initials: O
authors.lastname: Dahmani
authors.forename: P
authors.initials: P
authors.lastname: Demarchi
authors.forename: C
authors.initials: C
authors.lastname: Sophoclis
authors.forename: K
authors.initials: K
authors.lastname: Abi-Ayad
authors.forename: S
authors.initials: S
authors.lastname: Belkhalfa
authors.forename: J
authors.initials: J
authors.lastname: Djellid
mesh_terms: D000369:Aged, 80 and over; D001803:Blood Transfusion; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002454:Cell Differentiation; D004844:Epistaxis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008479:Mediastinal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012008:Recurrence; D006435:Renal Dialysis; D012307:Risk Factors; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D004921:Erythropoietin