Nephrotic Syndrome, Mediastinal Mass, and Pulmonary Embolus

Abstract

BUMC PROCEEDINGS 2002;15:212–216 CASE PRESENTATION KEVIN P. THELEMAN, MD: A previously healthy 17-year-old white man in East Texas developed fever, cough, and malaise and was treated by his primary care physician for a presumed “walking pneumonia” that failed to resolve after treatment with azithromycin. Approximately 2 weeks after the onset of symptoms, edema appeared and progressed to anasarca. The patient was referred to a nephrologist. A kidney biopsy was recommended, but the patient’s parents opted for an empiric trial of prednisone. A 24-hour urine collection yielded 17.9 g of protein. The edema worsened despite furosemide and metolazone therapy. The edema lessened, however, with intravenous torsemide, but within 24 hours of this therapy, the patient had acute pleuritic chest pain. His PO2 level was 67 mm Hg, and Nephrotic syndrome, mediastinal mass, and pulmonary embolus